Fluconazole (Diflucan) is an approved anti-fungal drug. It works by inhibiting the synthesis of ergosterol, a main component in the fungal cell membrane.

Fluconazole is manufactured by Pfizer, but alternative generic versions are available in some countries. Fluconazole is available in capsules, a liquid for intravenous infusion or a solution to be drunk.

Fluconazole is licensed for treating candidiasis and cryptococcal meningitis, and for preventing recurrences of cryptococcal meningitis after treatment^[1]. It is also active in HIV-positive adults and children^[2][3][4]. Fluconazole is also being tested as a treatment or prophylaxis for other fungal diseases such as aspergillosis, coccidioidomycosis and histoplasmosis.

Resistance to fluconazole can occur, particularly in people with more advanced HIV infection. In these cases, alternative anti-fungal drugs such as itraconazole (Sporanox) or ketoconazole (Nizoral) may be used.

People who are starting fluconazole treatment for candidiasis or meningitis are usually recommended to start with a higher loading dose of 400mg daily before reducing the dose to the standard 200mg daily^[5]. The dose of fluconazole should be reduced in people who have kidney impairment.

Fluconazole’s commonest side-effect is upset stomach. In rare cases, it can also cause clinically important, even fatal liver inflammation. Skin rashes have also been reported, primarily in people taking fluconazole at the same time as several other drugs. Other occasional side-effects include nausea and vomiting, headache, seizures, Stevens-Johnson syndrome and hair loss^[6].

Fluconazole causes an approximate doubling of nevirapine (Viramune) levels, increasing the risk of liver toxicity. Nevirapine does not affect fluconazole levels^[7]. Fluconazole also increases the blood levels of tipranavir (Aptivus)^[8]. Does of more than 200mg fluconazole are not recommended in patients taking tipranavir.