Canazole

Indications for Canazole

Canazole (Fluconazole) is prescribed for the treatment of various fungal infections, including:

• Vaginal Candidiasis
• Oropharyngeal Candidiasis
• Oesophageal Candidiasis
• Tinea Infections (Tinea corporis, Tinea cruris, Tinea pedis, etc.)
• Kerion
• Pityriasis Versicolor
• Onychomycosis (Fungal Nail Infections)
• Invasive Candidiasis & Cryptococcal Infections, including Cryptococcal Meningitis
• Prevention of Cryptococcal Meningitis
• Prevention of Fungal Infections in immunocompromised patients
• Systemic Candidiasis & Cryptococcal Infections

Other Indications:

• Fungal Urinary Tract Infections
• Disseminated Candidiasis
• Fungal Infection Prophylaxis in neutropenic cancer patients
• Treatment of Systemic Fungal Infections such as coccidioidomycosis and histoplasmosis

Note: Always use as directed by a registered healthcare provider.

Pharmacology

Canazole (Fluconazole) is a powerful triazole antifungal medication. It works by inhibiting fungal cytochrome P-450 enzymes, which are crucial for synthesizing ergosterol, an essential component of the fungal cell membrane.

Dosage & Administration

For Adults:

• Vaginal Candidiasis: 150 mg as a single dose
• Oropharyngeal Candidiasis: 200 mg on Day 1, followed by 100 mg daily for 14 days
• Oesophageal Candidiasis: 200 mg on Day 1, followed by 100 mg daily for 14-30 days
• Tinea Infections: 150 mg weekly for 4-6 weeks
• Kerion: 50 mg daily for 20 days
• Pityriasis Versicolor: 400 mg as a single dose
• Onychomycosis (Nail Infections): 150 mg weekly for up to 12 months
• Invasive Candidiasis & Cryptococcal Infections: 400 mg on Day 1, then 200-400 mg daily (oral or IV)
• Prevention of Cryptococcal Meningitis: 200 mg daily (oral or IV)
• Immunocompromised Patients: 50-400 mg daily (oral or IV)

For Children (Over 1 Year):

• Superficial Candidiasis: 1-2 mg/kg daily
• Systemic Candidiasis & Cryptococcal Infections: 3-6 mg/kg daily

Adjustments for Life-Threatening Infections: Up to 12 mg/kg daily for children aged 5-13 years (Maximum 400 mg/day)

Special Dosing Instructions for Children:

• 1 year (9 kg): ½ measuring spoonful
• 1-2 years (12 kg): 1 measuring spoonful
• 2-3 years (14 kg): 1½ measuring spoonful
• 3-4 years (16 kg): 2 measuring spoonful
• 4-6 years (20 kg): 2½ measuring spoonful

Use in Specific Populations:

• Elderly Patients: Standard dose unless renal impairment is present
• Renal Impairment: Adjust the dosage interval based on creatinine clearance:
  • Creatinine clearance > 41 ml/min: Standard dose
  • Creatinine clearance 21-40 ml/min: Dose every 48 hours
  • Creatinine clearance 10-20 ml/min: Dose every 72 hours
  • For Dialysis Patients: One dose after each dialysis session

Drug Interactions

Canazole may interact with several medications. Key interactions include:

• Warfarin: Can increase prothrombin time; monitoring is recommended.
• Oral Sulfonylureas: Can enhance the effect, leading to possible hypoglycemia.
• Hydrochlorothiazide: May increase fluconazole levels by 40%.
• Phenytoin: May elevate phenytoin levels significantly.
• Rifampicin: Can reduce fluconazole’s efficacy by 25%.
• Oral Contraceptives: No significant effect with 50 mg fluconazole; 200 mg daily may slightly increase hormone levels.
• Cyclosporine: Fluconazole can increase cyclosporine levels in renal transplant patients.
• Theophylline: Fluconazole can reduce the clearance of theophylline by 18%.

Contraindications

Fluconazole should not be used by individuals allergic to Fluconazole or other triazole compounds.

Side Effects

Common side effects include:

• Gastrointestinal Issues: Nausea, abdominal discomfort, diarrhea, and gas
• Rash: Rarely occurs (less than 1%)
• Anaphylaxis: Very rare reactions

Pregnancy & Lactation

Fluconazole has been shown to cause fetal harm in animal studies at doses significantly higher than therapeutic levels. Therefore, it should be avoided during pregnancy unless absolutely necessary, and women of childbearing potential should use effective contraception during treatment. Fluconazole is excreted in breast milk, so its use during breastfeeding is not recommended.

Warnings & Precautions

Patients with severe underlying conditions such as AIDS or cancer may experience changes in liver, kidney, or other biochemical functions during treatment.

• Liver Toxicity: Monitor liver function closely in patients with elevated liver enzymes.
• Severe Skin Reactions: Rarely, severe skin reactions like Stevens-Johnson syndrome may occur, especially in patients with AIDS.
• Discontinue Treatment: If a rash develops in patients with superficial infections or severe reactions with systemic infections, discontinue fluconazole immediately.

Use in Special Populations

• Elderly: Adjust doses if renal function is compromised.
• Renal Impairment: Adjust dosage intervals based on creatinine clearance.

Overdose Effects

If overdose occurs, symptomatic treatment and supportive measures should be employed. Hemodialysis can remove approximately 50% of the drug from the bloodstream.

Storage

Store in a dry place, away from heat and light. Keep out of reach of children.