Diflucan vs. itraconazole

• Diflucan (fluconazole) and itraconazole 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.
• Itraconazole is also used to treat fungal nails, aspergillosis, blastomycosis, histoplasmosis, as well as HIV and non-HIV infected individuals.
• Brand names for itraconazole include Sporanox, Onmel, and Sporanox Pulsepak.
• Side effects of Diflucan and itraconazole that are similar include nausea, diarrhea, dizziness, and rash.
• Side effects of Diflucan that are different from itraconazole include headache, abdominal pain, indigestion, low blood potassium (hypokalemia), and changes in taste.
• Side effects of itraconazole that are different from Diflucan include vomiting, fluid retention (edema), and fatigue.

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.

Diflucan

Common side effects of fluconazole include

• headache,
• nausea, and
• abdominal pain.

Other important side effects include

• diarrhea,
• dyspepsia,
• dizziness,
• reduced blood levels of potassium,
• rash, and
• taste disturbance.

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:

• nausea,
• vomiting,
• diarrhea,
• rash,
• edema,
• fatigue,
• dizziness.

Other important side effects include:

• High blood pressure (hypertension) and
• increased blood triglycerides.

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:

• unusual fatigue,
• poor appetite,
• nausea and/or vomiting,
• yellowing of the eyes (jaundice),
• dark urine or
• pale stool.

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).

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.

Diflucan

• Hydrochlorothiazide increases the blood concentration of fluconazole by 40%. However, dosage modification is not recommended when both drugs are combined.
• Rifampin (Rifadin, Rimactane, Rifadin, Rifater, Rifamate) reduces the blood concentration of oral fluconazole, probably by increasing the elimination of fluconazole in the liver; therefore, reducing the effectiveness of fluconazole.
• Fluconazole may increase the concentration of warfarin (Coumadin, Jantoven) in blood by reducing the elimination of warfarin. Therefore, the effect of warfarin may increase, leading to an increased tendency to bleed.
• Fluconazole also increases the concentration of the following drugs in the blood, and as a result, the risk of side effects of these drugs may increase. These drugs include:
  • phenytoin (Dilantin),
  • cyclosporine,
  • zidovudine (Retrovir),
  • saquinavir (Invirase),
  • theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin),
  • tolbutamide,
  • glyburide (Micronase, Diabeta, Glynase),
  • glipizide,
  • triazolam (Glucotrol),
  • midazolam (Versed),
  • celecoxib (Celebrex),
  • fentanyl (Sublimaze),
  • atorvastatin (Lipitor),
  • simvastatin (Zocor), and
  • lovastatin (Mevacor).
• As a result, the risk of side effects from the above drugs may increase.
• Combining fluconazole with amiodarone (Cordarone), pimozide (Orap), bepridil (Vascor) or other drugs that affect heart rhythm may increase the risk of abnormal heart rhythms.

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).

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.