Diflucan - Fluconazole

Most prescriptions for Diflucan or its generic fluconazole are for women with vaginal yeast infection caused by Candida albicans. For acute vulvovaginitis due to this yeast, a high degree of cure results from just 1 tablet taken only one time. Women receiving ongoing antibiotic therapy may need an additional pill every 3 days until discontinuing the antibiotic.

The situation becomes somewhat more complicated in the relatively large group of women with frequent recurrences of vulvovaginal candidiasis. These women may benefit by weekly therapy with fluconazole for up to 6 months. Most of these individuals experience recurrences for unknown reasons. Standard risk factors are not routinely present. Rather the underlying cause most likely represents a flaw in the body’s immune mechanisms for dealing with yeast.

Another explanation for frequent recurrences involves a relative of Candida albicans known as Candida glabrata. Unfortunately this later organism resists the action of fluconazole along with many of the popular topical anti-yeast products. Culture may assist in determining how to proceed.

Risks associated with fluconazole, especially a single dose, seem relatively uncommon. Recent studies cast doubt on whether the drug should be prescribed for pregnant women, a group especially prone to recurrent yeast infections. The large Quebec Pregnancy Cohort published in February 2019 discovered an increased rate of miscarriages and heart defects associated with fluconazole during pregnancy. Topical Monistat seems a safer alternative.

Diflucan also finds use in people suffering from oral or esophageal yeast infection. Higher doses for a more prolonged interval seem necessary. At times Candida may cause urinary tract infection or pneumonia. Diflucan remains the drug of choice for these situations as well. It also may be appropriate to prescribe the drug prophylactically in transplant recipients and in people with a low white blood cell count resulting from certain therapies.

A common skin condition, Tinea versicolor, presents as small patchy slightly tan to white areas on the surface of the skin. It tends to attack the upper arms, chest and back. Typically asymptomatic, they become noticeable during the summer months when they resist tanning. The cause is a yeast known as Malassezia. Although not closely related to Candida, Malassezia often responds to fluconazole at a dose of 150 or 300 mg once weekly for several weeks. As with Candida, the Malassezia remain present even after therapy. The condition almost always recurs.

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