Diflucan vs. itraconazole

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Diflucan vs. itraconazole

What is Diflucan? What is itraconazole?

Diflucan (fluconazole) is an anti-fungal medication that prevents growth of fungi by preventing production of the membranes that surround fungal cells. It is related to clotrimazole (Lotrimin), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Micatin, Monistat). Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation.

Itraconazole is an anti-fungal drug used to treat fungal infections such as fungal nails, aspergillosis, blastomycosis, histoplasmosis, and candidiasis, as well as HIV and non-HIV infected individuals. Itraconazole is in the same drug class as fluconazole (Diflucan), ketoconazole (Nizoral), and miconazole (Micatin, Monistat). It prevents growth of several types of fungi by preventing the fungi from producing the membranes that surround the fungal cells.

What are the side effects of Diflucan and itraconazole?

Diflucan

Common side effects of fluconazole include

Other important side effects include

Possible serious side effects include

  • seizures,
  • reduced number of white blood cells,
  • reduced number of blood platelets, and
  • toxic epidermal necrolysis.

Rarely, serious allergic reactions, including angioedema (swelling of tissues), may also occur. Liver dysfunction (jaundice, hepatitis) and abnormal heart beats have been associated with fluconazole. Stevens-Johnson syndrome has also been reported.

Itraconazole

The most common side effects of itraconazole are:

Other important side effects include:

Less common but more serious side effects include hepatitis and congestive heart failure.
It is important to report any signs or symptoms that may suggest liver dysfunction so that the appropriate laboratory testing can be done. These signs include:

Itraconazole should not be used for treatment of onychomycosis in patients with a history of heart failure. It should be discontinued if signs and symptoms of heart failure occur. Symptoms of heart failure include fatigue, edema (fluid retention), shortness of breath, nausea, abdominal pain, and inability to sleep unless sitting upright. Use of calcium channel blockers may increase the risk of heart failure associated with itraconazole (see drug interactions).

What is the dosage of Diflucan vs. itraconazole?

Diflucan

  • The usual adult dose is 50-400 mg daily depending on the type of infection. Although symptoms of oral Candida infections may subside in a few days, treatment is continued for 2 weeks.
  • Esophageal Candida infections are treated for 3 weeks or longer.
  • Treatment of cryptococcal meningitis may last for 10-12 weeks after cerebrospinal fluid cultures become negative.

Itraconazole

The usual recommended dose is 200-400 mg daily as a single dose or two divided doses. Capsules should be taken with a full meal because food improves absorption. The capsule and liquid are not interchangeable, and only the liquid form is used for treating oral candidiasis.

What drugs interact with Diflucan and itraconazole?

Diflucan

Itraconazole

Itraconazole reduces the liver metabolism (breakdown) of some drugs, resulting in increased blood levels and side effects from the affected drugs. Life-threatening adverse effects occurred when itraconazole was combined with cisapride (no longer available in the U.S.), pimozide (Orap), quinidine (Quinaglute, Quinidex), dofetilide (Tikosyn), or levomethadyl (Orlaam). Therefore, itraconazole should not be combined with these drugs.

HMG CoA-reductase inhibitors or "statins" such as simvastatin (Zocor) or lovastatin (Mevacor) should also not be combined with itraconazole due to the risk of serious adverse effects.

Other drugs whose blood levels are increased by itraconazole include warfarin (Coumadin), tolbutamide, glyburide (Micronase, Diabeta, Glynase), glipizide (Glucotrol), protease inhibitors (for example, indinavir [Crixivan], ritonavir [Norvir], saquinavir [Invirase, Fortovase]), midazolam (Versed), triazolam (Halcion) and several others.
Itraconazole increases blood levels of certain calcium channel blockers, for example, nisoldipine (Sular) and verapamil (Calan). Such combinations increase the occurrence of congestive heart failure due to itraconazole. Itraconazole increases blood levels of tacrolimus, sirolimus, and cyclosporine. It may also increase blood levels of fentanyl or prolong elimination of fentanyl, potentially leading to fatal respiratory depression. Clarithromycin (Biaxin), erythromycin, indinavir (Crixivan) or ritonavir (Norvir) increase blood levels of itraconazole by reducing its elimination from the liver, resulting in increased side effects of itraconazole.

Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), rifabutin (Mycobutin) and isoniazid reduce the blood concentration of oral itraconazole, probably by increasing the elimination of itraconazole by the liver. This may reduce the effectiveness of itraconazole. Itraconazole tablets require acid from the stomach to dissolve. Therefore, itraconazole should be administered at least two hours before taking antacids or other acid reducing medications such as cimetidine (Tagamet), ranitidine (Zantac) or omeprazole (Prilosec).

Are Diflucan and itraconazole safe to use while pregnant of breastfeeding?

Diflucan

  • There are no adequate studies of Diflucan in pregnant women. There are reports of harmful effects to the fetus when high dose fluconazole was administered to pregnant women for a few months. Use of fluconazole during pregnancy is not recommended.
  • Diflucan is secreted in breast milk at concentrations similar to the mother's blood level. However, fluconazole is used for treating neonates with fungal infections and for treating lactation associated Candida infections. Available evidence suggests that use of fluconazole during breastfeeding has little risk.

Itraconazole

  • Itraconazole has not been adequately studied in pregnant women. Cases of congenital abnormalities have been reported. Itraconazole should not be used to treat nail fungal infections (onychomycosis) in pregnant patients. Women of childbearing age undergoing treatment for fungal infections of the nails must use adequate contraception measures while receiving itraconazole and for two months after treatment.
  • Itraconazole is excreted in human milk. Therefore, it should not be administered to nursing women or, alternatively, breastfeeding should be discontinued.

Summary

Diflucan (fluconazole) and itraconazole (Sporanox) are anti-fungal medications used to treat fungal infections caused by Candida. Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation.

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Medically Reviewed on 1/18/2019
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