Fact Sheet 534
Fluconazole (Diflucan)
WHY DO PEOPLE WITH HIV TAKE IT?
HOW DOES IT REACT WITH OTHER DRUGS?
Fluconazole is an antifungal drug. In the US, 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 fungus. Fluconazole fights opportunistic infections in people with HIV. Pfizer manufactures it. Baxter manufactures the generic version approved in 2000.
WHY DO PEOPLE WITH HIV TAKE IT?
Fluconazole is used when fungal infections can’t be treated with skin lotions or creams. It works against several different types of fungus, including the yeast infection called candidiasis or 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.” People with advanced HIV disease can get opportunistic infections.
See Fact Sheet 500 for more information on Opportunistic Infections.
The yeast infection candidiasis, or thrush, is fairly common. It can be more serious in people with HIV. See Fact Sheet 501 for more information on thrush. Another opportunistic infection, cryptococcal meningitis, is discussed in Fact Sheet 503. Fluconazole has been approved to treat both of these infections.
However, a recent study found that people being treated for cryptococcal meningitis had a high risk of immune reconstitution disease (IRIS, see fact sheet 483) if they started anti-HIV therapy. The researchers suggest delaying HIV treatment until the meningitis infection is cleared.
Some doctors also use fluconazole to treat other opportunistic infections caused by fungus.
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 fight 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 fight thrush.
Many doctors 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.
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 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 doctor might need to reduce your dose of fluconazole.
You can take fluconazole with or without food.
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.
Pregnant women or women who are breastfeeding should not take fluconazole.
HOW DOES IT 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 fight HIV. However, fluconazole interacts with indinavir (Crixivan), ritonavir (Norvir), and zidovudine (Retrovir, AZT). 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 doctor knows about all the medications you are taking.
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