Active substanceFluconazoleFluconazole
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  • Dosage form: & nbspsolution for infusions
    Composition:

    1 ml of solution contains:

    Active substance: fluconazole - 2 mg

    Excipients: sodium chloride - 9 mg, water for injection - up to 1 ml.

    Description:
    Transparent colorless liquid.

    Pharmacotherapeutic group:Antifungal agent.
    ATX: & nbsp

    J.02.A.C   Triazole derivatives

    J.02.A.C.01   Fluconazole

    Pharmacodynamics:
    Fluconazole is a representative of the class of triazole antifungal agents, it is a selective inhibitor of the synthesis of sterols in the fungal cell. The drug is active in mycoses caused by Candida spp., Cryptococcus neoformans, Microsporum spp., Trichophyton spp., Blastomyces dermatidis, Coccidioides immitis and Histoplasma capsulatum.

    Pharmacokinetics:
    After intravenous administration fluconazole well penetrates into tissues and body fluids. Concentrations of the drug in saliva and sputum are similar to those in plasma. In patients with fungal meningitis, the fluconazole content in the cerebrospinal fluid reaches 80% of the corresponding levels in the plasma.
    Concentrations in the plasma are in direct proportion to the dose. Ninety percent of the equilibrium concentration level is reached by 4-5 days after several administrations at a dose per day.
    The use on the first day of a dose that is twice the usual daily dose allows one to achieve plasma levels of the drug that approach 90% of the equilibrium concentrations by the second day. The apparent volume of distribution approximates the total volume of fluid in the body. A small fraction of fluconazole (11-12%) binds to plasma proteins.Half-life is long (30 hours).
    Fluconazole is excreted from the body mainly by the kidneys; while approximately 80% of the administered dose is excreted unchanged. The clearance of fluconazole is in direct proportion to the creatinine clearance. Metabolites in the peripheral blood were not detected.

    Indications:
    Fluconazole is used to treat the following diseases:
    1. Cryptococcosis: cryptococcal meningitis, cryptococcal infections of the lungs and skin; prevention of recurrence of cryptococcosis in AIDS patients, organ transplantation or in other cases of immunodeficiency.
    2. Generalized Candidomycosis: candidemia, disseminated candidiasis and other forms of invasive candidiasis infections (infections of the abdominal cavity, endocardium, eyes, respiratory and urinary tracts).
    3. Candidomycosis of mucous membranes: oral cavity, pharynx, esophagus and non-invasive bronchopulmonary infections, candiduria.
    4. Vaginal candidiasis is acute or in a chronic recurrent form.
    5. Prevention of fungal infections in patients with malignant neoplasms that are predisposed to such infections as a result of chemotherapy with cytostatics or radiation therapy.

    Contraindications:
    The use of fluconazole is contraindicated in patients with hypersensitivity to the drug or to a similar structure of azole compounds.
    Contraindicated simultaneous use of terfenadine, astemizole and cisapride.
    Contraindicated in lactation.

    Carefully:
    Hepatic insufficiency, the appearance of rash against the background of fluconazole in patients with superficial fungal infection and invasive / systemic fungal infections, potentially pro-rhythmic conditions in patients with multiple risk factors (organic heart disease, disorders, electrolyte balance, simultaneous use of drugs that cause arrhythmias), pregnancy.

    Pregnancy and lactation:
    The use of the drug in pregnancy is contraindicated, except for severe, generalized and potentially life-threatening fungal infections.

    Dosing and Administration:
    Fluconazole in the form of a solution for injection is injected intravenously at a rate of no more than 20 mg (10 ml) / min. When transferring from intravenous administration to taking capsules and vice versa, there is no need to change the daily dose.
    The infusion solution is compatible with the following solvents: 20% glucose solution, Ringer's solution, Hartman's solution, potassium chloride solution in glucose, 4.2% bicarbonate sodium solution, aminofusin, isotonic sodium chloride solution.
    Infusions of fluconazole can be carried out using conventional transfusion kits using one of the liquids listed above.
    Application in adults.
    In cryptococcal infections, the usual dose of fluconazole is 400 mg once a day on the first day of treatment, later on - 200-400 mg once a day. The duration of treatment for cryptococcal infections depends on the clinical efficacy, confirmed by mycological examination; usually varies from 6 to 8 weeks.
    To prevent the recurrence of cryptococcal meningitis in AIDS patients after completing the full course of primary therapy fluconazole appoint a patient in doses of at least 200 mg / day for a long period.
    With candidemia, disseminated candidiasis and other invasive, candidal infections, the daily dose is 400 mg on the first day and 200 mg on subsequent days. Depending on the clinical effectiveness of the drug, the dose can be increased to 400 mg / day. The duration of treatment depends on clinical effectiveness.
    In oropharyngeal candidiasis, including patients with impaired immunity, the usual dose is 50-100 mg once a day for 7-14 days. If necessary, the treatment can be prolonged, especially with severe immunity disorders.
    In other candidiasis infections, for example, with esophagitis, noninvasive bronchopulmonary infections, candiduria, candidiasis of the skin and mucous membranes, the usual daily dose is 50-100 mg for 14-30 days.
    For the prevention of fungal infections in patients with malignant neoplasms, the dose fluconazole but should be 50 mg once a day as long as the patient is at high risk because of cytostatic therapy or radiation therapy.
    Use in children.
    As with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. For children, the daily dose of the drug should not exceed that of adults. Fluconazole apply daily once a day.
    In candidiasis of mucous membranes, the recommended dose of fluconazole is
    3 mg / kg / day. On the first day, in order to achieve the steady-state equilibrium concentrations more quickly, a shock dose of 6 mg / kg can be administered.
    For the treatment of generalized candidiasis and cryptococcal infection, the recommended dose is 6-12 mg / kg / day, depending on the severity of the disease.
    For the prevention of fungal infections in patients with depressed immunity, which the risk of infection is associated with neurophenia, which develops as a result of cytotoxic chemotherapy or radiation therapy, the drug is prescribed at 3-12 mg / kg / day, depending on the severity and duration of preservation of induced neurosy (see dosage for adults, for children with kidney failure - see dosage with renal insufficiency.)
    Use in children aged 4 weeks or less.
    In newborns fluconazole output slowly. In the first 2 weeks of life the drug is prescribed in the same dose (mg / kg) as for older children, but at an interval of 72 hours. Children at the age of 3 and 4 weeks of life are administered the same dose at intervals of 48 hours.
    Application in the elderly
    In the absence of impaired renal function, the usual dosage recommendations should be followed. For patients with impaired renal function (creatinine clearance <50 mL / min), the dosage regimen should be adjusted as indicated below.Use in patients with renal insufficiency.
    Fluconazole is excreted primarily through the kidneys in an unchanged form. With a single admission dose changes are not required. In patients (including children) with impaired renal function, when taking the drug again, a "shock" dose of 50 mg to 400 mg should be initially administered. After the introduction of the "shock" dose, the daily dose (depending on the indication) is determined according to the following table:

    Creatinine clearance (ml / min)

    Percent recommended dose

    >50

    100%

    <50 (without dialysis)

    50%

    Patients permanently on dialysis

    100% after each dialysis session

    Side effects:
    On the part of the digestive system: nausea, diarrhea, flatulence, abdominal pain, taste change, vomiting, rarely - impaired liver function (jaundice, hyperbilirubinemia, increased activity of aminotransferases and alkaline phosphatase, hepatitis, hepatocellular necrosis), incl. with a lethal outcome.
    From the nervous system: headache, dizziness, rarely - convulsions.
    On the part of the organs of hematopoiesis: rarely - leukopenia, thrombocytopenia, neutropenia, agranulocytosis.
    Allergic reactions: skin rash, rarely - multiforme exudative erythema (incl.Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome), anaphylactoid reactions (including angioedema, facial edema, urticaria, skin itching).
    From the cardiovascular system: an increase in the duration of the Q-T interval, fibrillation / flutter of the ventricles.
    Other: rarely - a violation of kidney function, alopecia, hypercholesterolemia,
    hypertriglyceridemia, hypokalemia.

    Overdose:
    Symptoms: hallucinations, paranoid behavior.
    If the drug is overdosed, symptomatic treatment may be sufficient. Fluconazole is excreted mainly through the kidneys; The forced diuresis, probably, can accelerate deducing of a preparation from an organism. After a three-hour hemodialysis, fluconazole concentrations in the blood plasma are reduced by approximately 50%.

    Interaction:
    Anticoagulants: in patients receiving fluconazole and coumarin
    anticoagulants, careful monitoring of prothrombin time is necessary, as it may increase.
    Oral hypoglycemic agents (sulfonylureas: fluconazole can prolong the half-life of sulfonylurea derivatives, therefore, when combined, the possibility of developing hypoglycemia should be considered.
    Phenytoin: simultaneous application of fluconazole and phenytoin may
    accompanied by an increase in the concentration of phenytoin in a clinically significant degree, which requires a reduction in its dose.
    Rifampicin: with simultaneous administration of rifampicin and fluconazole
    the maximum concentration and the half-life of the latter decrease, therefore, if a combined use is necessary, the dose of fluconazole should be increased.
    Rifabutin: combined use of fluconazole and rifabutin is accompanied by an increase in serum levels of the latter, possibly the development of uveitis.
    Cyclosporine: when combined with fluconazole and cyclosporine
    it is recommended to monitor the concentration of the latter in the blood, because it can increase.
    Terfenadine and astemizole: Given the occurrence of serious, life-threatening, arrhythmias in patients who have received azole antifungal agents in combination with terfenadine or astemizole, their joint administration is contraindicated.
    Cisapride: with simultaneous administration of fluconazole and cisapride, cases of adverse cardiac reactions, including paroxysms of ventricular tachycardia, have been described. Simultaneous reception is contraindicated.
    Zidovudine: when combined, zidovudine concentrations in the blood plasma may increase. Patients receiving this combination should be observed to identify side effects of zidovudine.
    Theophylline: administration of fluconazole leads to a decrease in the average rate of clearance of creatinine from the blood plasma, hence the risk of toxic theophylline and overdose increases.
    Although no specific manifestations of pharmaceutical incompatibility are described, mixing of fluconazole solution with solutions of other drugs before infusion is not recommended.
    When using fluconazole in patients who simultaneously receive other drugs metabolized by the cytochrome P450 system, care must be taken.

    Special instructions:
    In rare cases, the use of fluconazole was accompanied by toxic effects on the liver, including fatal, mainly in patients with serious concomitant diseases. It is necessary to monitor liver function. If there are signs of liver damage that may be associated with the use of fluconazole, the drug should be discontinued.
    In the course of treatment, it is necessary to monitor blood counts, kidney function.If there are violations of the kidneys should stop taking the drug.
    When skin rashes occur in patients with immunosuppression, careful observation is necessary, in the case of progression of the skin reaction, treatment should be discontinued (the risk of Stevens-Johnson syndrome, Lyell syndrome).

    Form release / dosage:Solution for infusions 2 mg / ml.
    Packaging:
    To 50 ml in bottles of colorless glass, ukuporennye rubber stoppers with obakkoy caps aluminum. A plastic sticker-holder is attached to the bottle. 1 bottle together with the instruction for use is placed in a pack of cardboard.

    Storage conditions:
    List B. In the dark place at a temperature of +5 ° C to +30 ° C.
    Keep out of the reach of children.

    Shelf life:
    3 years. The drug should not be used after the expiry date indicated on the package.

    Terms of leave from pharmacies:On prescription
    Registration number:P N001360 / 01
    Date of registration:04.07.2008
    The owner of the registration certificate:PHARMSTANDART-FORESTRY, OJSC PHARMSTANDART-FORESTRY, OJSC Russia
    Manufacturer: & nbsp
    Representation: & nbspDALHIMFARM, OJSCDALHIMFARM, OJSC
    Information update date: & nbsp18.10.2015
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