WHAT IS FLUCONAZOLE?
Fluconazole is an antifungal drug. In the U.S., its brand name is Diflucan. It is sold under many different names in other parts of the world. Antifungals fight infections caused by different kinds of fungi. Fluconazole fights opportunistic infections (OIs) in people with HIV.
WHY DO PEOPLE WITH HIV TAKE FLUCONAZOLE?
Fluconazole is used when fungal infections can’t be treated with skin lotions or creams. It works against several different types of fungi, including the yeast infection called candidiasis (thrush).
Many germs live in our bodies or are common in our surroundings. A healthy immune system can fight them off or keep them under control. However, HIV infection can weaken the immune system. Infections that take advantage of weakened immune defenses are called opportunistic infections (OIs). People with advanced HIV disease can get OIs.
The yeast infection candidiasis, or thrush, is fairly common. It can be more serious in people with HIV. Fluconazole is also used to treat another OI, cryptococcal meningitis. Fluconazole has been approved to treat both of these infections.
Some doctors also use fluconazole to treat other OIs caused by fungi.
WHAT ABOUT DRUG RESISTANCE?
Whenever you take medication, be sure to take all of the prescribed doses. Many people stop if they feel better. This is not a good idea. If the drug doesn’t kill all of the germs, they might change (mutate) so that they can survive even when you are taking medications. When this happens, the drug will stop working. This is called developing resistance to the drug.
For example, if you are taking fluconazole to treat thrush and you miss too many doses, the thrush in your body could develop resistance to fluconazole. Then you would have to take a different drug or combination of drugs to treat thrush.
Many healthcare providers prefer to treat thrush with creams or lozenges that dissolve in the mouth. Thrush is much less likely to develop resistance when the treatment is applied directly to the infection instead of through the whole body.
HOW IS FLUCONAZOLE TAKEN?
Fluconazole is available in several forms. It comes in tablets of 50, 100, 150, or 200 milligrams (mg). It is also available in granules to prepare a liquid form and as a liquid for intravenous (IV) use. The dose and the length of time you will take it depend on the type of infection you have.
If you have had kidney problems, your healthcare provider might need to reduce your dose of fluconazole.
You can take fluconazole with or without food.
WHAT ARE THE SIDE EFFECTS?
The most common side effects of fluconazole are headache, nausea, and pain in the abdomen. A few people get diarrhea. Most antiretroviral medications (ARVs) cause problems in the digestive system. Fluconazole could make those problems worse.
Fluconazole can be hard on the liver. Your doctor will probably watch your lab results carefully for any sign of liver damage. Let your doctor know if your urine gets dark or your bowel movements get light-colored.
Fluconazole can also cause kidney damage. Let your doctor know if you notice a rapid increase in your weight or if any part of your body gets swollen.
In rare cases, fluconazole can cause a serious reaction (Stevens-Johnson syndrome) that shows up as a skin rash.
People who are pregnant or breastfeeding should not take fluconazole.
HOW DOES FLUCONAZOLE REACT WITH OTHER DRUGS?
Fluconazole is processed mostly by the kidneys. It does not interact very much with drugs that use the liver, including most ARVs used to treat HIV. However, fluconazole interacts with the protease inhibitor (PI) ritonavir (Norvir). It also interacts with several other types of drugs. These include some blood thinners, seizure medications, water pills (diuretics), pills to lower blood sugar, and other antibiotics. Be sure your healthcare provider knows about all the medications you are taking.
THE BOTTOM LINE
Fluconazole is used to treat candidiasis and cryptococcal meningitis, opportunistic infections in people with HIV. The most common side effects of fluconazole are headache, nausea, and abdominal pain.
Reviewed March 2021Print PDF