Drug Uses

Diflucan is indicated for the treatment of:
-Vaginal candidiasis (vaginal yeast infections due to Candida).
-Oropharyngeal and esophageal candidiasis.
-Cryptococcal meningitis.
Diflucan is also indicated to decrease the incidence of candidiasis in patients undergoing bone marrow transplantation who receive cytotoxic chemotherapy and/or radiation therapy.

How Taken

Diflucan comes as a tablet and liquid to take by mouth. It is usually taken once a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Diflucan exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Shake the liquid well before each use to mix the medication evenly. Continue to take Diflucan even if you feel well. Do not stop taking Diflucan without talking to your doctor.

Warnings/Precautions

Do not take Diflucan if you are taking cisapride (Propulsid). Combined with cisapride (Propulsid), Diflucan could cause serious, even fatal, heart problems. Before taking Diflucan, tell your doctor if you have any other medical conditions, especially kidney disease, or if you take other medicines. You may not be able to take Diflucan, or you may require a dosage adjustment or special monitoring during your treatment. Diflucan is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Do not take Diflucan without first talking to your doctor if you are pregnant or could become pregnant during treatment. Diflucan passes into breast milk and may be harmful to a nursing baby. For this reason, Diflucan should not be taken by nursing mothers. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

Missed Dose

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Possible Side Effects

If you experience any of the following serious side effects, stop taking Diflucan and seek emergency medical attention or contact your doctor immediately: an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); liver damage (pale stools, yellowing of the skin or eyes, abdominal pain, unusual fatigue, or dark urine); or a rash. Other, less serious side effects may be more likely to occur. If you experience any of the following side effects, continue taking Diflucan and talk to your doctor: nausea, vomiting, or abdominal pain; diarrhea; headache; dizziness; fatigue; or itching. Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Storage

Store tablets below 86°F (30°C). Protect from freezing. Diflucan injections in Viaflex Plus plastic containers are available in both sodium chloride and dextrose diluents. Store between 77°F (25°C) and 41°F (5°C). Brief exposure up to 104°F (40°C) does not adversely affect the product. Protect from freezing.

Overdose

Seek emergency medical attention if an overdose is suspected. Symptoms of a Diflucan overdose include confusion, hallucinations, paranoia, decreased movement, decreased breathing, tearing eyes, drooling, urinary incontinence, seizures, and death.

More Information

Avoid alcohol or use it in moderation while taking Diflucan. Alcohol and Diflucan can both affect the liver. Use caution when driving or performing other hazardous activities. Diflucan may cause dizziness. If you experience dizziness, avoid these activities.

Disclaimer

This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.

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Many of us have been jaded by the constant onslaught of “the latest” medical news, much of which seems to contradict what we just heard or read about the week before. But on July 9, millions of us – patients and health care providers alike – paid rapt attention when the federal government’s National Institutes of Health released findings from a major clinical trial, warning of the risks associated with a widely used type of hormone replacement therapy (HRT) that combines two female hormones, estrogen and progestin. It’s estimated that 6 million postmenopausal American women currently take Prempro or similar combined estrogen-progestin drugs to ease menopause symptoms and to improve their health and well-being. Risks Outweigh Benefit, Study Found The study, called the Women’s Health Initiative (WHI), found that the combined drugs caused increases in breast cancer, heart attacks, strokes and blood clots. Although the risk to an individual woman may be small, the number of cases occurring in the population at large can be great, researchers said. And those risks outweigh the drugs' actual benefits – a small decrease in hip fractures and a decrease in cases of colorectal cancer. The study was released four years earlier than expected because of researchers’ concerns. The WHI study is the first-ever long-term randomized controlled clinical trial – considered the gold standard by medical researchers – of hormone replacement therapy. The WHI was established in 1991 by the government to address the most common causes of death, disability and impaired quality of life in postmenopausal women. The Medical College of Wisconsin is one of 40 WHI clinical sites nationwide where study participants are seen and monitored. The Women’s Health Initiative is a 15-year multimillion-dollar endeavor, and one of the largest US prevention studies of its kind. The study was designed to look at the effects not only of HRT, but also diet modification and vitamin and mineral supplements. Some 67,000 women from across the country, ranging in age from 50 to 79, are participating in the WHI clinical trials. In addition to those women, the study is also following the medical history and health habits of an additional 100,000 women to examine the relationship between lifestyle, health and risk factors with specific disease outcomes. Final results are due out in 2006. More than 16,600 US women are participating in the combined estrogen-progestin portion of the trial, among them 438 women who are in the Medical College of Wisconsin group. They were sent letters telling them to discontinue taking those drugs. The WHI is continuing to study the effects of ERT, or estrogen-alone drugs, used by women who have had a hysterectomy. WHI has not stopped that portion of the study. Jane Morley Kotchen, MD, Professor and Director of Epidemiology at MCW, is the principal investigator for MCW’s portion of the study. She admits she was caught by surprise by the early release. "The breast cancer risks for women on the combined estrogen-progestin therapy are similar to risks that have been found in other studies,” she notes, although she says the cardiovascular findings were not anticipated. “A decreased risk of coronary heart disease had been hypothesized for women on active hormone therapy, so the finding of slightly greater risks for women on the active hormone therapy was unexpected. Overall, the health risks for women taking combined estrogen plus progestin therapy were found to outweigh the benefits. The trial was stopped because the risk-benefit balance, as indicated by a global indicator of overall risk, was unfavorable and the breast cancer risks crossed the predetermined safety boundaries." The WHI’s Data and Safety Monitoring Board – an independent advisory committee charged with reviewing results and ensuring participant safety – set the limits of acceptable risk for breast cancer at an unusually low level of cases per thousand. When that level was reached, the trial was stopped and results were released early. Another Medical College faculty member who served as a WHI investigator agreed that the early release of the findings was surprising. For Vanessa Barnabei, MD, PhD, the medical risks and benefits that caused such a national media furor when the WHI released its combined estrogen-progestin study results had been indicated by earlier patient studies, although earlier studies were regarded as “observational,” and had not met the strict standards of the WHI. Dr. Barnabei is an Associate Professor of Obstetrics and Gynecology at MCW and Director of MCW Physicians’ Division of General Obstetrics and Gynecology. "Early harm from heart disease and stroke were suggested several years ago, and women in the study were informed about it at that time,” Dr. Barnabei says. “And the breast cancer risks have been suspected. The numbers and magnitude of risk are no different today than they were then. Risk ‘Relatively Small’ for Individual Women In a news release from the NIH on July 9, Jacques Rossouw, MD, acting director of the WHI, summarized the risk findings: "The WHI results tell us that during one year, among 10,000 postmenopausal women with a uterus [as opposed to those who have had their uterus removed] who are taking estrogen plus progestin, eight more will have invasive breast cancer, seven more will have a heart attack, eight more will have a stroke, and 18 more will have blood clots, including eight with blood clots in the lungs, than will a similar group of 10,000 women not taking these hormones. This is a relatively small annual increase in risk for an individual woman,” he said. Dr. Barnabei said that she found it interesting that the WHI has continued with the estrogen-only portion of the study. She says scientists have known that progestin can act to influence breast growth and development while reducing the risk of uterine cancer. And an article in the January 26, 2000, Journal of the American Medical Association reported that researchers at the National Cancer Institute had found that women who are current or recent users of combined estrogen and progestin had a higher relative risk of breast cancer than women who only take estrogen. What Patients Should Know Dr. Rossouw, the acting WHI director, offered this advice: “Women with a uterus who are currently taking estrogen plus progestin should have a serious talk with their doctors to see if they should continue it. If they are taking this hormone combination for short-term relief of symptoms, it may be reasonable to continue, since the benefits are likely to outweigh the risks. Longer term use or use for disease prevention must be re-evaluated, given the multiple adverse effects noted in WHI." Dr. Barnabei says she always cautions patients about the potential for increased breast cancer risks. First, she rules out women who are not candidates for HRT– those with vaginal bleeding of an unknown cause, suspected breast cancer or history of breast cancer, history of endometrial cancer or certain cancers of the uterus, chronic liver disease such as cirrhosis or a history of blood clots. For women who are eligible for HRT, the primary reason for HRT is symptom relief, she says, with less emphasis on using hormone therapy for disease prevention: “I explain the known risks and benefits. And I do remind them that the risk for breast cancer does increase naturally for all women as they age, along with heart disease and osteoporosis." Dr. Barnabei tells her patients who want to stop HRT that they can certainly quit anytime. “First of all, with menopause, we’re not treating a disease,” she says. “Stopping HRT has no major consequences except perhaps a return of menopausal symptoms.”

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