Diflucan

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Diflucan on Prescriptsy

Diflucan is described on Prescriptsy as independent product information.

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Diflucan is the brand name for fluconazole, a triazole antifungal medicine widely used in the United Kingdom for the treatment of fungal infections.

It is most commonly prescribed as a single 150 mg capsule for vaginal candidiasis (thrush), but is also used to treat oral and oesophageal candidiasis, dermatophyte skin infections, and serious systemic fungal infections including cryptococcal meningitis.

Fluconazole was first licensed in the UK in 1988 and has become one of the most frequently dispensed antifungal agents in both primary and secondary care.

Generic fluconazole preparations are widely available alongside the original Diflucan brand.

Fungal infections are extremely common.

Vaginal thrush affects approximately 75% of women at least once during their lifetime, and recurrent thrush (four or more episodes per year) affects around 5 to 8% of women.

Oral candidiasis is prevalent in denture wearers, immunocompromised patients, those using inhaled corticosteroids, and infants.

Serious invasive fungal infections, while less common, carry significant morbidity and mortality in hospitalised and immunosuppressed individuals.

This page provides a comprehensive clinical overview of how Diflucan works, the infections it treats, correct dosing for each indication, side effects, safety warnings, drug interactions, and how to obtain it in the UK.

Important safety information about Diflucan

Before reading further, note the following essential safety points.

• A single 150 mg fluconazole capsule for vaginal thrush is available without prescription from UK pharmacies (pharmacy medicine, P). All other uses require a prescription.
• Fluconazole interacts with many medicines including warfarin, sulfonylureas, phenytoin, and statins. Always declare all current medications before starting treatment.
• Fluconazole should be avoided during pregnancy except for life-threatening infections. Topical azole treatments are preferred for thrush in pregnancy.
• Rare but serious side effects include liver damage and severe skin reactions. Seek immediate medical attention if you develop jaundice, a widespread blistering rash, or swelling of the face or throat.
• Fluconazole can prolong the QT interval on the electrocardiogram. Use with caution if you have heart disease or take other QT-prolonging medicines.

Understanding fungal infections

Fungi are ubiquitous micro-organisms found in the environment and on the human body.

Under normal conditions, the immune system and competition from resident bacteria keep fungal populations in check.

When this balance is disrupted, whether by antibiotics, immunosuppression, hormonal changes, or mucosal damage, fungi can proliferate and cause infection.

Candida species are the most common cause of human fungal infections.

Candida albicans is the predominant species, responsible for the majority of vaginal thrush, oral thrush, and invasive candidiasis cases. Non-albicans species including C. glabrata, C. tropicalis, and C.

krusei account for a growing proportion of infections, particularly in immunocompromised patients and those with prior azole exposure.

Awareness of species distribution is important because some non-albicans species have reduced susceptibility to fluconazole.

Dermatophyte fungi (Trichophyton, Microsporum, and Epidermophyton species) cause superficial skin infections including tinea corporis (ringworm), tinea pedis (athlete's foot), tinea cruris (jock itch), and onychomycosis (fungal nail infection).

While topical antifungals are first-line for most dermatophyte infections, oral fluconazole is an option for extensive or refractory cases.

Cryptococcus neoformans causes cryptococcal meningitis, a life-threatening infection that primarily affects individuals with advanced HIV or other forms of severe immunosuppression. Fluconazole plays a central role in the consolidation and maintenance phases of cryptococcal meningitis treatment.

How Diflucan works: mechanism of action

Fluconazole belongs to the triazole class of antifungal agents.

It exerts its effect by inhibiting the fungal enzyme lanosterol 14-alpha-demethylase (CYP51), a cytochrome P450-dependent enzyme essential for the biosynthesis of ergosterol.

Ergosterol is a structural component of the fungal cell membrane, analogous to cholesterol in human cell membranes.

When ergosterol synthesis is blocked, the fungal cell membrane becomes unstable and permeable, leading to leakage of intracellular contents and inhibition of cell growth and division.

Fluconazole's selectivity for the fungal CYP51 enzyme over human cytochrome P450 enzymes is the basis for its relatively favourable safety profile, though it does inhibit certain human CYP enzymes (particularly CYP2C9 and CYP3A4), accounting for its drug interaction potential.

Key pharmacokinetic properties of fluconazole include excellent oral bioavailability (greater than 90%), extensive tissue distribution with good penetration into cerebrospinal fluid, saliva, sputum, and vaginal secretions, and a long plasma half-life of approximately 30 hours.

These properties allow once-daily dosing and make fluconazole suitable for treating infections at diverse body sites.

Indications and clinical evidence

Vaginal candidiasis

Fluconazole 150 mg as a single oral dose is the standard treatment for uncomplicated vaginal thrush and is at least as effective as topical azole regimens.

A Cochrane review found no significant difference in clinical cure rates between oral and intravaginal azole treatments for acute vulvovaginal candidiasis.

The convenience of a single oral dose contributes to high patient acceptability and adherence.

Oropharyngeal and oesophageal candidiasis

Fluconazole at 50 to 100 mg daily for 7 to 14 days is the recommended first-line treatment for oral thrush in immunocompromised patients according to British HIV Association (BHIVA) and NICE guidance.

For oesophageal candidiasis, higher doses and longer courses (14 to 30 days) are required.

Systemic candidiasis

Fluconazole at 400 mg daily (following a loading dose of 800 mg on day one) is used for candidaemia and invasive candidiasis in haemodynamically stable patients infected with susceptible Candida species.

Echinocandins are preferred empirically in critically ill patients pending species identification and susceptibility testing.

Cryptococcal meningitis

Fluconazole 400 to 800 mg daily is the recommended consolidation and maintenance therapy following induction with amphotericin B and flucytosine, as per BHIVA and WHO guidelines.

Treatment is prolonged, typically 8 weeks of consolidation followed by at least 12 months of maintenance at 200 mg daily in patients with HIV.

Dermatophyte infections

Fluconazole 50 mg daily or 150 mg weekly can be used for tinea infections not responding to topical treatment. However, terbinafine is generally preferred for dermatophyte infections including onychomycosis because of superior cure rates against dermatophyte species.

Dosage and administration

Diflucan capsules should be swallowed whole with water and can be taken with or without food.

Oral suspension is available for patients who cannot swallow capsules, including young children; shake the bottle well before measuring each dose.

Intravenous fluconazole is available for patients unable to take oral medication and is used in hospital settings.

Dosing varies by indication. For vaginal thrush, a single 150 mg capsule is sufficient.

For oral thrush, the usual dose is 50 mg once daily for 7 to 14 days.

For more serious infections, doses of 200 mg to 400 mg daily are used under specialist direction. In renal impairment, doses must be reduced according to creatinine clearance.

Full dosing schedules are detailed in the dosage information section above.

Side effects of Diflucan

Common side effects

The most frequently reported side effects are headache, nausea, abdominal pain, diarrhoea, and rash.

These are generally mild and self-limiting, especially with short courses such as the single 150 mg dose for vaginal thrush.

Transient elevation of liver enzymes (AST, ALT) may be detected on blood tests during prolonged treatment.

Uncommon and rare side effects

Less common effects include dizziness, taste disturbance, vomiting, fatigue, decreased appetite, and insomnia.

Rare but potentially serious adverse effects include hepatotoxicity (liver damage ranging from enzyme elevation to hepatic necrosis and liver failure), severe cutaneous reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), anaphylaxis, QT prolongation, torsade de pointes, and haematological abnormalities including agranulocytosis and thrombocytopenia.

When to seek urgent medical attention

Stop taking Diflucan and seek emergency medical care (call 999 or attend A&E) if you develop jaundice (yellowing of skin or eyes), dark urine, severe abdominal pain, widespread blistering skin rash, swelling of the face, lips, tongue, or throat, or difficulty breathing.

Contact your GP or NHS 111 for persistent nausea, unexplained fatigue, palpitations, or any new symptoms that concern you.

Report adverse reactions via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Liver function

Fluconazole has been associated with rare cases of serious hepatotoxicity, including fatal outcomes, primarily in patients with serious underlying medical conditions.

Liver function tests should be monitored before and during prolonged treatment or at high doses. Discontinue fluconazole if clinical signs of hepatic disease develop.

Pregnancy and breastfeeding

Fluconazole should be avoided in pregnancy except for life-threatening systemic infections. Case reports of high-dose or prolonged first-trimester exposure have described a pattern of congenital anomalies.

For vaginal thrush in pregnancy, topical clotrimazole pessary and cream are the preferred first-line treatments.

A single 150 mg dose during breastfeeding is generally considered acceptable, but repeated or high-dose courses should be discussed with a healthcare professional.

Cardiac effects

Fluconazole can prolong the QT interval on the ECG, which may predispose to serious cardiac arrhythmias.

This risk is increased in patients with structural heart disease, electrolyte imbalances (especially low potassium or magnesium), or concurrent use of other QT-prolonging drugs.

An ECG may be recommended before starting treatment in at-risk patients.

Drug interactions

Fluconazole is a potent inhibitor of CYP2C9 and a moderate inhibitor of CYP3A4, leading to clinically significant interactions with many medicines.

Warfarin levels increase substantially; INR should be monitored closely and warfarin dose adjusted. Sulfonylurea hypoglycaemics (glipizide, glibenclamide) may cause hypoglycaemia. Phenytoin, ciclosporin, tacrolimus, and sirolimus levels are increased.

Simvastatin and atorvastatin levels may rise, increasing the risk of rhabdomyolysis.

Fluconazole must not be given with certain QT-prolonging drugs metabolised by CYP3A4 (terfenadine at doses above 400 mg, cisapride, pimozide, quinidine, erythromycin).

Always provide a complete medication list to your prescriber.

How to get Diflucan in the UK

A single 150 mg fluconazole capsule for vaginal thrush can be purchased from any UK pharmacy without a prescription (pharmacy medicine, P).

The pharmacist will ask a few screening questions to ensure it is appropriate.

For all other indications, doses, and durations, fluconazole is a prescription-only medicine available through your GP or hospital specialist.

Authorised online prescribers can also issue prescriptions following an appropriate clinical assessment.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Preventing recurrent thrush

If you experience recurrent vaginal thrush, practical measures may help reduce frequency alongside any maintenance treatment your GP prescribes. Wear loose-fitting cotton underwear and avoid synthetic fabrics.

Use a gentle, unperfumed wash for the vulval area and avoid soap, shower gels, and bubble bath in contact with the genital area. Avoid unnecessary antibiotic use.

If you have diabetes, optimising blood glucose control can reduce candidal infections. Probiotics are widely marketed for thrush prevention, but high-quality evidence for their effectiveness remains limited.

When to seek further medical advice

Contact your GP or NHS 111 if thrush symptoms do not resolve within 7 days of a single fluconazole dose, if you experience recurrent thrush (four or more episodes in 12 months), or if you are unsure whether your symptoms are caused by thrush.

Conditions such as bacterial vaginosis, sexually transmitted infections, and vulval dermatoses can mimic thrush and require different treatment.

Seek urgent care if you develop signs of systemic infection (fever, rigors, feeling very unwell) or signs of serious adverse drug reactions as described in the warnings section.

Sources

• Diflucan 150 mg Capsules, Summary of Product Characteristics (EMC)
• Fluconazole, British National Formulary (BNF)
• NICE CKS: Candida, female genital
• Thrush, NHS
• BHIVA guidelines for treatment of opportunistic infections in HIV
• MHRA Yellow Card Scheme