Diflucan capsules 150mg N4
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Active ingredients
Fluconazole
Release form
Capsules
Composition
Capsules, composition (1 caps.): Active substance: fluconazole - 150 mg. Adjuvants: lactose - 149,123 mg; corn starch - 49.5 mg; colloidal silicon dioxide - 0.352 mg; magnesium stearate - 3.173 mg; sodium lauryl sulfate - 0.352 mg capsule composition: for dosage of 150 mg: titanium dioxide (E171) - 1.47%, gelatin - up to 100%; patented blue (E131) dye - 0.03% ink for marking on capsules: shellac glaze - 63%; ferric oxide black (E172) - 25%; N-butyl alcohol - 8.995%; industrial methylated spirit 74 EF - 2%; soy lecithin - 1%; antifoam component DC - 0,005% 1510
Pharmacological effect
antifungal
Pharmacokinetics
It has similar pharmacokinetic parameters with a / in the introduction and ingestion. After oral administration, fluconazole is well absorbed, its plasma levels (and total bioavailability) exceed 90% of plasma levels of fluconazole upon i.v. administration. Simultaneous ingestion does not affect the absorption of the drug when taken orally. Cmax in plasma is reached in 0.5–1.5 h after ingestion of fluconazole on an empty stomach, and T1 / 2 is about 30 h. The concentration in plasma is proportional to the dose. 90% of Css is reached by the 4–5th day of drug treatment (with repeated administration 1 time per day). Administration of a loading dose (on day 1), twice the normal daily dose, makes it possible to achieve 90% Css co 2 th day Vd is approaching total body water. Protein binding is low (11–12%). Fluconazole penetrates well into all body fluids. Fluconazole concentrations in saliva and sputum are similar to plasma concentrations. In patients with fungal meningitis, the concentration of fluconazole in the cerebrospinal fluid is about 80% of its concentration in plasma. In the stratum corneum, epidermis-dermis and sweat fluid, high concentrations are reached that exceed the serum levels. Fluconazole builds up in the stratum corneum. When taken in a dose of 50 mg 1 time per day, the concentration of fluconazole after 12 days is 73 mcg / g, and 7 days after stopping treatment - only 5.8 mcg / g. When used at a dose of 150 mg 1 time per week, the concentration of fluconazole in the stratum corneum on the 7th day is 23.4 mcg / g, and 7 days after taking the second dose - 7.1 mcg / g. The concentration of fluconazole in the nails after 4 - monthly application in a dose of 150 mg 1 time per week is 4.05 mcg / g in healthy and 1.8 mcg / g in affected nails; 6 months after completion of therapy, fluconazole is still detected in the nails. The drug is excreted mainly by the kidneys; approximately 80% of the administered dose is found unchanged in the urine. Fluconazole clearance is proportional to creatinine clearance.Circulating metabolites were not found. Durable T1 / 2 from plasma allows you to take fluconazole once for vaginal candidiasis and once a day or once a week for other indications. When comparing concentrations in saliva and plasma after a single dose of 100 mg of fluconazole in capsule form and suspension (rinsing, preservation in the mouth for 2 minutes and swallowing) found that Cmax of fluconazole in saliva when taking the suspension was observed 5 minutes after ingestion and 182 times higher than that after taking the capsule (reached after 4 hours). After about 4 hours, the concentrations of fluconazole in saliva were the same. AUC (0–96) in saliva was significantly higher when administered as a suspension than capsules. Significant differences in the rate of excretion from saliva or plasma pharmacokinetics using two dosage forms were not detected. Pharmacokinetics in children The following pharmacokinetic parameters were obtained in children: Age Dose, mg / kg T1 / 2, h AUC, mcg · h / ml11 days - 11 months Once, in / in, 3 mg / kg 23 110.19 months - 13 years Once, by mouth, 2 mg / kg 25 94.79 months - 13 years Once, by mouth, 8 mg / kg 19.5 362.55– 15 years Repeatedly, in / in, 2 mg / kg 17.4 * 67.4 * 5–15 years Repeatedly, in / in, 4 mg / kg 15.2 * 139.1 * 5–15 years Repeatedly, in / in - 8 mg / kg 17.6 * 196.7 * Average age of 7 years Multiple, int 3 mg / kg 15.5 41.6 * Last-day indicator For premature babies (about 28 weeks of development), fluconazole was administered IV at a dose of 6 mg / kg every 3rd day prior to the administration of a maximum of 5 doses at that time , while the children remained in the intensive care unit. The average T1 / 2 was 74 hours (44–185 hours) on the 1st day, with a decrease on the 7th day — to an average of 53 hours (30–131 hours) and on the 13th day — an average of 47 hours (27–68 h). The AUC values were 271 mcg · h / ml (173–385 mcg · h / ml) on day 1, then increased to 490 mcg / h · ml (292–734 mcg · h / ml ) on the 7th day and decreased on average to 360 mcg · h / ml (167–566 mcg · h / ml) by the 13th day. The Vd was 1183 ml / kg (1070–1470 ml / kg) in 1– then increased on average to 1184 ml / kg (510–2130 ml / kg) on the 7th day and to 1328 ml / kg (1040–1680 ml / kg) on the 13th day. The pharmacokinetics in elderly patients a single use of fluconazole in a dose of 50 mg orally MI patients aged 65 years and older, some of whom took diuretics at the same time, found that plasma Cmax was reached 1.3 h after administration and was 1.54 μg / ml, AUC mean values (76.4 ± 20, 3) mcg · h / ml, and the average T1 / 2 - 46.2 hours. The values of these pharmacokinetic parameters are higher than in young patients.The simultaneous intake of diuretics did not cause a pronounced change in AUC and Cmax. C creatinine (74 ml / min), the percentage of the drug excreted in the urine in unchanged form (0–24 h, 22%) and the renal clearance of fluconazole (0.124 ml / min / kg) in elderly patients is lower compared with young. Higher pharmacokinetic parameters in elderly patients taking fluconazole are likely to be associated with decreased renal function, which is characteristic of older age.
Indications
cryptococcosis, including cryptococcal meningitis and infections of other localization (for example, lungs, skin), including in patients with normal immune response and AIDS patients, recipients of transplanted organs and patients with other forms of immunodeficiency; supportive therapy to prevent the recurrence of cryptococcosis in AIDS patients; generalized candidiasis, including candidemia, disseminated candidiasis and other forms of invasive candidal infection, such as infections of the peritoneum, endocardium, eyes, respiratory and urinary tract, including in patients with malignant tumors in intensive care units who receive cytotoxic or immunosuppressive agents, as well as in patients with other factors predisposing to the development of candidiasis, mucosal candidiasis, including mucous membranes of the mouth and throat, esophagus, non-invasive broncho-pulmonary infections, Candiduria, skin-mucous and chronic atrophic candidiasis of the oral cavity (associated with the wearing of dental prostheses), including in patients with normal and suppressed immune function; prevention of recurrence of oropharyngeal candidiasis in patients with AIDS, genital candidiasis; acute or recurrent vaginal candidiasis; prevention to reduce the frequency of recurrences of vaginal candidiasis (3 or more episodes per year); candidal balanitis; prevention of fungal infections in patients with malignant tumors predisposed to such infections as a result of cytotoxic chemotherapy or radiation therapy; skin mycoses, including mycoses of the feet, body, inguinal region, pityrias, psoriasis, onychomycosis and skin candidosis, deep endemic mycoses in patients with normal immunity, coccidioidomycosis, paracoccidioidomycosis, sporotrichosis and histoplasmosis.
Contraindications
hypersensitivity to fluconazole, other components of the drug or azole substances with a structure similar to fluconazole, simultaneous use of terfenadine during repeated use of fluconazole at a dose of 400 mg / day or more (see "Interaction"); simultaneous use of cisapride (see "Interaction" ). With caution: impaired liver function indices with the use of fluconazole; the appearance of a rash on the background of the use of fluconazole in patients with surface fungal infection and invasive / systemic fungal infections; simultaneous use of terfenadine and fluconazole at a dose of less than 400 mg / day; potentially proarrhythmic conditions in patients with multiple risk factors (organic heart disease, electrolyte imbalance, and concomitant therapy promoting the development of such disorders).
Use during pregnancy and lactation
Adequate and well-controlled studies of pregnant women have not been conducted. Cases of multiple congenital malformations in newborns whose mothers for 3 months or more received high-dose fluconazole therapy (400-800 mg / day) for coccidioidomycosis have been described. The relationship between these disorders and taking fluconazole has not been established. During pregnancy, the use of fluconazole should be avoided, except in cases of severe and potentially life-threatening fungal infections, when the expected benefit of treatment outweighs the possible risk to the fetus. Therefore, women of childbearing age should use contraception. Fluconazole is found in breast milk at concentrations close to plasma, so its use in women during lactation is not recommended.
Dosage and administration
Capsules: inside, swallowing whole. Therapy can be started before obtaining the results of seeding and other laboratory tests. However, anti-infective therapy needs to be changed accordingly when the results of these studies become known. Fluconazole can be taken orally or administered intravenously by infusion at a rate of no more than 10 ml / min. The choice of method of administration depends on the clinical condition of the patient. When transferring a patient from IV to oral administration of the drug or vice versa, a change in the daily dose is not required.In the solution for iv injection fluconazole is dissolved in 0.9% sodium chloride solution; each 200 mg (100 ml bottle) contains 15 mmol of Na + and Cl-. Therefore, in patients who require limiting sodium or fluid intake, it is necessary to take into account the rate of fluid administration. The daily dose of Diflucan depends on the nature and severity of the fungal infection. In vaginal candidiasis in most cases, a single dose of the drug is effective. In case of infections requiring repeated use of the antifungal drug, treatment should be continued until the clinical or laboratory signs of an active fungal infection disappear. Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually need supportive therapy to prevent recurrence of the infection. Use in adults1. With cryptococcal meningitis and cryptococcal infections of other localization, 400 mg is usually prescribed on the 1st day, and then continue treatment at a dose of 200-400 mg once a day. The duration of treatment of cryptococcal infections depends on the presence of clinical and mycological effect; with cryptococcal meningitis, treatment is usually continued for at least 6–8 weeks. To prevent the recurrence of cryptococcal meningitis in AIDS patients, after completing the full course of primary treatment, therapy with Diflucan at a dose of 200 mg / day can be continued for a very long time.2. For candidaemia, disseminated candidiasis and other invasive candidal infections, the dose is usually 400 mg on day 1, then 200 mg / day. Depending on the severity of the clinical effect, the dose may be increased to 400 mg / day. The duration of therapy depends on the clinical efficacy. When oropharyngeal candidiasis, the drug is usually prescribed in 50-100 mg once a day for 7-14 days. If necessary, patients with pronounced suppression of immune function can continue treatment for a longer time. In atrophic oral candidiasis associated with the wearing of dentures, the drug is usually prescribed in a dose of 50 mg 1 time per day for 14 days in combination with local antiseptics for the treatment of the prosthesis. For other candidal infections of the mucous membranes (except for genital candidiasis, seebelow), for example, esophagitis, non-invasive broncho-pulmonary infections, candiduria, candidiasis of the skin and mucous membranes, etc., the effective dose is usually 50–100 mg / day for a duration of treatment of 14–30 days. To prevent recurrence of oropharyngeal candidiasis in patients After completing the full course of primary therapy, Diflucan can be given 150 mg once a week. 4. In case of vaginal candidiasis, Diflucan is prescribed once by mouth in a dose of 150 mg. To reduce the frequency of recurrences of vaginal candidiasis, the drug can be used in a dose of 150 mg once a month. The duration of therapy is determined individually; it varies from 4 to 12 months. Some patients may require more frequent use of the drug. The use of a single dose for children under 18 years of age and for patients over 60 years old is not recommended without a doctor's prescription. When balanitis is caused by Candida, Diflucan is prescribed once in a dose of 150 mg orally.5. For the prevention of candidiasis, the recommended dose of Diflucan is 50-400 mg 1 time per day, depending on the degree of risk of developing a fungal infection. For patients with a high risk of generalized infection, for example, with severe or prolonged neutropenia, the recommended dose is 400 mg 1 time per day. Diflucan is prescribed a few days before the expected development of neutropenia and after an increase in the number of neutrophils more than 1000 per mm3, the treatment is continued for another 7 days. For infections of the skin, including mycoses of the feet, smooth skin, inguinal area and candidal infections, the recommended dose is 150 mg 1 time per week or 50 mg 1 time per day. The duration of therapy is usually 2–4 weeks, however, for mycoses of the feet, longer therapy may be required (up to 6 weeks). In case of pityriasis, the recommended dose is 300 mg once a week for 2 weeks; some patients require a third dose of 300 mg / week, while for individual patients, a single dose of 300–400 mg is sufficient. An alternative treatment regimen is the use of the drug in 50 mg 1 time per day for 2-4 weeks. In tinea unguium (onychomycosis), the recommended dose is 150 mg 1 time per week. Treatment should be continued until the infected nail is replaced (the uninfected nail grows). For the re-growth of the nails on the fingers and feet it usually takes 3–6 and 6–12 months, respectively. However, the growth rate can vary widely among different people, as well as depending on age.After successful treatment of long-lasting chronic infections, a change in the shape of the nails is sometimes observed.7. With deep endemic mycoses, it may be necessary to use the drug at a dose of 200–400 mg / day for up to 2 years. The duration of therapy is determined individually; it is 11-24 months - with coccidioidomycosis; 2–17 months - with paracoccidioidomycosis; 1–16 months - with sporotrichosis and 3–17 months - with histoplasmosis. 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 for adults. Diflucan is used daily, 1 time per day. In case of mucosal candidiasis, the recommended dose of Diflucan is 3 mg / kg / day. On the first day, in order to achieve more permanent Css, a loading dose of 6 mg / kg can be prescribed. 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. To prevent fungal infections in patients with depressed immunity, in whom the risk of developing an infection is associated with neutropenia developing 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 induced neutropenia (see dosage for adults; for children with renal insufficiency — see dosage for patients with renal insufficiency). In children aged 4 weeks or less, fluconazole is slowly excreted in newborns. In the first 2 weeks of life, the drug is prescribed in the same dose (in mg / kg) as older children, but with an interval of 72 hours. Children at the age of 3 and 4 weeks the same dose is administered at intervals of 48 hours. The use in elderly In the absence of signs of renal failure, the drug is prescribed in the usual dose. In patients with renal insufficiency (Cl creatinine <50 ml / min), the dose of the drug is adjusted as described below. Use in patients with renal insufficiency Fluconazole is excreted mainly in the urine unchanged. With a single dose dose is not required. In patients (including children) with impaired renal function with repeated use of the drug should initially enter the loading dose of 50 to 400 mg,after which the daily dose (depending on the indication) is set as follows: Creatinine clearance, ml / min Recommended dose percentage> 50 100% <50 (without dialysis) 50% Regular dialysis 100% (after each dialysis) Instructions for preparing a suspension for receiving inside Preparation of suspension: add 24 ml of water to the contents of 1 bottle with powder for preparation of suspension and shake well. Shake before each use.
Side effects
Tolerability is usually very good. The following adverse reactions were most often noted in clinical and postmarketing (*) studies of Diflucan: From the central and peripheral nervous system: headache, dizziness *, cramps *, change in taste *. From the digestive tract: pain stomach, diarrhea, flatulence, nausea, dyspepsia *, vomiting *. On the side of the liver: hepatotoxicity, including rare cases with a fatal outcome, increased levels of alkaline phosphatase, bilirubin, serum levels of ALT and AST, abnormal liver function *, hepatitis *, hepatocellular necrosis *, jaundice *. On the skin and subcutaneous tissues: rash, alopecia *, exfoliative skin diseases *, including Stevens-Johnson syndrome and toxic necrolysis of the epidermis. On the side of the hematopoietic system and lymphatic system *: leukopenia, including neutropenia and agranulocytosis, thrombocytopenia. For the immune system *: anaphylaxis (including angioedema, swelling of the face, urticaria, pruritus). For CVS *: increased QT interval on the ECG, ventricular fibrillation / flutter (see section "Special instructions"). Metabolic / trophic disorders *: increased plasma cholesterol and triglycerides, hypokalemia. In some patients, especially those suffering from serious diseases such as AIDS or cancer, changes in blood indices and functions were observed during treatment with Diflucan and similar drugs kidney and liver (see section "Special instructions"), however, the clinical significance of these changes and their relationship to treatment has not been established.
Overdose
Symptoms: There are reports of fluconazole overdose, and in one case, a 42-year-old HIV-infected patient after taking 8200 mg of the drug appeared hallucinations and paranoid behavior.The patient was hospitalized; his condition returned to normal within 48 hours. Treatment: symptomatic treatment (including supportive measures and gastric lavage). Fluconazole is excreted mainly in the urine, so forced diuresis is likely to accelerate the excretion of the drug. A hemodialysis session lasting 3 hours reduces plasma plasma levels of fluconazole by about 50%.
Interaction with other drugs
Anticoagulants. Like other antifungal agents - azole derivatives, fluconazole, while used with warfarin, increases the PV (12%), and therefore may develop bleeding (hematomas, bleeding from the nose and gastrointestinal tract, hematuria, melena). In patients receiving coumarin anticoagulants, PV.Azithromycin should be continuously monitored. With simultaneous oral administration of fluconazole in a single dose of 800 mg with azithromycin in a single dose of 1200 mg of pronounced pharmacokinetic interaction between the two drugs is not installed. Benzodiazepines (short-acting). After ingestion of midazolam, fluconazole significantly increases the concentration of midazolam and psychomotor effects, and this effect is more pronounced after ingestion of fluconazole orally than when it is used intravenously. If necessary, concomitant therapy with benzodiazepines of patients taking fluconazole should be monitored with a view to appropriately reducing the dose of benzodiazepine. Zisapride. With the simultaneous use of fluconazole and cisapride, undesirable reactions of the heart are possible, including flicker / flutter of the ventricles (torsade de points). The use of fluconazole at a dose of 200 mg 1 time per day and cisapride at a dose of 20 mg 4 times a day leads to a pronounced increase in plasma concentrations of cisapride and an increase in the QT interval on the ECG. Simultaneous use of cisapride and fluconazole is contraindicated. Cyclosporine. In patients with a transplanted kidney, the use of fluconazole at a dose of 200 mg / day leads to a slow increase in the concentration of cyclosporine. However, with repeated administration of fluconazole at a dose of 100 mg / day, no change in the concentration of cyclosporin in bone marrow recipients was observed. With simultaneous use of fluconazole and cyclosporine, it is recommended to monitor the concentration of cyclosporine in the blood. Hydrochlorothiazide.Repeated use of hydrochlorothiazide simultaneously with fluconazole leads to an increase in plasma concentration of fluconazole by 40%. The effect of this severity does not require a change in the dosage regimen of fluconazole in patients receiving diuretics at the same time, but the physician should take this into account. Oral contraceptives. With simultaneous use of a combined oral contraceptive with fluconazole at a dose of 50 mg, no significant effect on hormone levels has been established, whereas with daily administration of 200 mg of fluconazole AUC ethinyl estradiol and levonorgestrel increases by 40 and 24%, respectively, and when receiving 300 mg of fluconazole once a week - AUC of ethinyl estradiol and norethindrone increase by 24 and 13%, respectively. Thus, repeated use of fluconazole in these doses is unlikely to affect the effectiveness of combined oral contraceptives. Phenytoin. The simultaneous use of fluconazole and phenytoin may be accompanied by a clinically significant increase in the concentration of phenytoin. If necessary, the simultaneous use of both drugs should monitor the concentration of phenytoin and adjust its dose accordingly to ensure therapeutic serum concentrations. Rifabutin. The simultaneous use of fluconazole and rifabutin can lead to an increase in serum concentrations of the latter. With the simultaneous use of fluconazole and rifabutin, cases of uveitis are described. Patients receiving rifabutin and fluconazole at the same time must be carefully monitored. Rifampicin. The simultaneous use of fluconazole and rifampicin leads to a decrease in AUC by 25% and the duration of T1 / 2 fluconazole by 20%. In patients taking rifampicin at the same time, it is necessary to take into account the feasibility of increasing the dose of fluconazole. Sulfonylurea preparations. Fluconazole, when taken simultaneously, leads to an increase in T1 / 2 of oral sulfonylurea drugs (chlorpropamide, glibenclamide, glipizide, and tolbutamide). Patients with diabetes mellitus can be prescribed the combined use of fluconazole and oral sulfonylurea drugs, but the possibility of hypoglycemia should be considered. Tacrolimus.The simultaneous use of fluconazole and tacrolimus leads to an increase in serum concentrations of the latter. Cases of nephrotoxicity are described. Patients taking both tacrolimus and fluconazole should be carefully monitored. Terfenadine. With the simultaneous use of azole antifungal agents and terfenadine, serious arrhythmias may occur as a result of an increase in the QT interval. When taking fluconazole at a dose of 200 mg / day, an increase in the QT interval is not established, however, the use of fluconazole at doses of 400 mg / day and above causes a significant increase in plasma terfenadine concentration. Simultaneous administration of fluconazole in doses of 400 mg / day or more with terfenadine is contraindicated (see section “Contraindications”). Fluconazole treatment in doses of less than 400 mg / day in combination with terfenadine should be carefully monitored. Theophylline. With simultaneous use with fluconazole at a dose of 200 mg for 14 days, the average plasma clearance rate of theophylline is reduced by 18%. When prescribing fluconazole to patients taking theophylline in high doses, or to patients with an increased risk of the toxic action of theophylline, the symptoms of the theophylline overdose should be observed and, if necessary, the therapy should be adjusted accordingly. Zidovudin. With simultaneous use with fluconazole, there is an increase in zidovudine concentrations, which is likely due to a decrease in the metabolism of the latter to its main metabolite. Before and after therapy with fluconazole at a dose of 200 mg / day for 15 days, patients with AIDS and ARC (AIDS-related complex) showed a significant increase in zidovudine AUC (20%). When used in HIV-infected patients, zidovudine at 200 mg every 8 hours for 7 days in combination with fluconazole at a dose of 400 mg / day or without it, with a 21 day interval between the two regimens, a significant increase in the AUC of zidovudine (74%) was established with simultaneous use with fluconazole. Patients receiving this combination should be monitored to detect side effects of zidovudine. Simultaneous use of fluconazole with astemizole or other drugs whose metabolism is carried out by the cytochrome P450 system may be accompanied by an increase in serum concentrations of these agents.With the simultaneous appointment of fluconazole, in the absence of reliable information, care must be taken. Patients should be carefully observed. Studies of the interaction of oral forms of fluconazole with its simultaneous intake with food, cimetidine, antacids, as well as after total body irradiation to prepare for bone marrow transplantation showed that these factors do not have a clinically significant effect on the absorption of fluconazole. The listed interactions have been established with repeated use of fluconazole; drug interactions as a result of a single dose of fluconazole are not known. Doctors should take into account that interaction with other drugs has not been specifically studied, but it is possible.
special instructions
In rare cases, the use of fluconazole was accompanied by toxic changes in the liver, including fatal, mainly in patients with serious concomitant diseases. In the case of hepatotoxic effects associated with the use of fluconazole, they are not marked by their apparent dependence on the total daily dose of the drug, the duration of therapy, sex and age of the patient. The hepatotoxic effect of the drug was usually reversible; his symptoms disappeared after cessation of therapy. Patients in whom liver function indices are violated during drug treatment should be monitored in order to identify signs of more serious liver damage. When clinical signs or symptoms of liver damage appear that may be associated with the use of fluconazole, the drug should be discontinued. As with the use of other azoles, fluconazole can rarely cause anaphylactic reactions. During treatment with fluconazole, patients rarely developed exfoliative skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. AIDS patients are more likely to develop severe skin reactions with the use of many drugs. When a patient has a surface rash that can be associated with fluconazole during treatment, the drug should be discontinued. When a rash appears in patients with invasive / systemic fungal infections, they should be carefully monitored and the drug withdrawn when a bullous lesion or erythema multiforme appears. Simultaneous use of fluconazole at doses of less than 400 mg / day and terfenadine should be carried out under careful control (see "Interaction") Like other azoles, fluconazole can cause an increase in the QT interval on an ECG.With the use of fluconazole, an increase in the QT interval and ventricular flicker / flutter were very rarely observed in seriously ill patients with multiple risk factors, such as organic heart disease, electrolyte imbalance, and concomitant development-promoting disorders. Therefore, in such patients with potentially proarrhythmic conditions, fluconazole should be used with caution. Patients with liver, heart and kidney diseases are advised to consult a physician before using the drug. When using Diflucan 150 mg for vaginal candidiasis, patients should be warned that symptom improvement is usually observed after 24 hours, but sometimes it takes several days to completely disappear. If symptoms persist for several days, you should consult a doctor. Diflucan, solution for IV administration, is compatible with the following solutions: - 20% glucose solution; - Ringer's solution; - Hartmann solution; - potassium chloride solution in glucose; - 4, 2% sodium bicarbonate solution; - aminoufine; - isotonic saline solution. Diflucan can be introduced into the infusion system along with one of the above solutions. Although cases of specific incompatibility of fluconazole with other drugs are not described, however, it is not recommended to mix it with any other drugs before the infusion. Impact on the ability to drive a car or perform work requiring increased speed of physical and mental reactions. Experience with the use of Diflucan indicates that a violation of the ability to drive a car and mechanisms associated with the use of the drug is unlikely.