Fluconazole side effects
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Fluconazole Side Effects: A Comprehensive Overview
Common Side Effects of Fluconazole
Fluconazole, a widely used antifungal medication, is generally well-tolerated but can cause several side effects. The most frequently reported side effects are gastrointestinal issues such as nausea, vomiting, and diarrhea . In pediatric populations, gastrointestinal symptoms were the primary reason for discontinuation of the drug in 3.2% of cases. Additionally, skin-related side effects like rash and xerosis (dry skin) are also common .
Long-Term Fluconazole Therapy Side Effects
Long-term use of fluconazole, especially in treating chronic conditions like coccidioidomycosis, can lead to more severe side effects. A significant number of patients (51.6%) on long-term therapy reported adverse effects, including xerosis, alopecia (hair loss), and fatigue. Approximately two-thirds of these patients required therapeutic interventions such as dose reduction or switching to another antifungal.
Liver and Biliary System Effects
Fluconazole can affect liver function, although these effects are generally self-limiting. Elevated liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were observed in a small percentage of patients . Regular liver function monitoring is recommended for patients on prolonged fluconazole therapy to prevent potential liver damage.
Neurological and Systemic Side Effects
Neurological side effects, although rare, can occur with fluconazole. These include headaches, dizziness, and in severe cases, polyneuropathy (PNP) and confusional states . One case study reported a patient developing severe neurological symptoms, including PNP and acute renal insufficiency, after taking fluconazole for a month.
Cardiac Side Effects
Fluconazole has been associated with QT prolongation, which can lead to serious arrhythmias like Torsades de Pointes and sudden death. This effect is due to fluconazole's inhibition of the hERG K(+) channel, which is crucial for cardiac repolarization. Additionally, fluconazole can interact with other medications, such as beta-blockers and immunosuppressants, increasing the risk of bradycardia and cardiac arrest.
Drug Interactions
Fluconazole is a known inhibitor of cytochrome P-450 enzymes, which can lead to significant drug interactions. For instance, it can increase the serum levels of medications like zidovudine and tacrolimus, potentially leading to toxicity . However, studies have shown that fluconazole does not significantly interact with cyclosporin, making it a safer option for patients on this immunosuppressant.
Conclusion
While fluconazole is generally well-tolerated, it can cause a range of side effects, particularly with long-term use. Common side effects include gastrointestinal and skin issues, while more severe effects can impact the liver, nervous system, and heart. Regular monitoring and awareness of potential drug interactions are crucial for minimizing risks associated with fluconazole therapy.
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