কিছু 𝐅𝐮𝐧𝐠𝐚𝐥 𝐢𝐧𝐟𝐞𝐜𝐭𝐢𝐨𝐧 এ ফ্লুকোনাজল বেশ ভালো কাজ করে…এইটার Advantage হলো ,এটি 𝐎𝐫𝐚𝐥 & 𝐈𝐕 দুইভাবেই পাওয়া যায় & বাচ্চাদের সিরাপ ও…..Half life ও বেশি! & Drug Interaction ও কম!!
খুব Rarely Liver toxicity করে। তবে High Dose এ দিলে 𝐀𝐥𝐨𝐩𝐞𝐜𝐢𝐞 ,𝐃𝐫𝐲 𝐦𝐨𝐮𝐭𝐡,𝐌𝐞𝐭𝐚𝐥𝐥𝐢𝐜 𝐭𝐚𝐬𝐭𝐞 হতে পারে…
𝐂𝐫𝐲𝐩𝐭𝐨𝐜𝐨𝐜𝐜𝐚𝐥 𝐌𝐞𝐧𝐢𝐧𝐠𝐢𝐭𝐢𝐬 এ ফ্লুকোনাজল কে prefer করা হয় & Drug Of choice !!
IV route এ দিল Amphotericin B এর সমান Effective ***
𝐂𝐚𝐧𝐝𝐢𝐝𝐞𝐦𝐢𝐚 তে ICU পেশেন্ট দের With নরমাল WBC কাউন্ট..(ImmuneSuppressed না হলে Candidemia তে ইউস করা হয়..)
Molds & Dimorphic fungi এর বিরুদ্ধে Fluconazole তেমন Effactive না
প্রেগ্ন্যাসির তে Low Dose এ ও দেওয়া যাবে না Miscarriage & Still birth হতে পারে।
Fluconazole যেহেতু Liver কে তেমন damage করে না ,তাই liver Disease এ High risk Pt এর ক্ষেত্রে Prophylaxis এ প্রেফার করা হয় Also Allogeneic bone marrow transplants .. এখন Posoconazole ও দেয়া হয়..
ফ্লুকোনাজল prophylaxis in leukemic পেশেন্ট ;AIDS পেশেন্ট with low CD4+ T-cell counts, and in patients on surgical intensive care units is controversial….
Capsule 1:-Flugal 150mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).
Indications of Capsule :-Flugal 150mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).
Flugal is indicated in-
- Vaginal Candidiasis
- Oropharyngeal Candidiasis
- Esophageal Candidiasis
- Tinea corporis/Tinea cruris/Tinea pedis/Other Tinea
- Kerion
- Pityriasis versicolor
- Onychomycosis
- Invasive candidal infections and cryptococcal infections (including meningitis)
- Prevention of cryptococcal meningitis
- Prevention of fungal infections in immunocompromised patients
- Systemic Candidiasis and Cryptococcal infection
- In Superficial Candidiasis
- In Systemic Candidiasis & Cryptococcal infection
Other indications-
- Fungal urinary tract infections
- Disseminated candidiasis
- Prophylaxis for fungal infection in neutropenic cancer patients.
- Acute treatment of other systemic fungal infections such as coccidioidomycosis and histoplasmosis.
Pharmacology of Capsule :-Flugal 150mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).
Fluconazole is a triazole antifungal agent. It is a potent inhibitor of fungal cytochrome P-450 dependent enzymes. Cytochrome P-450 enzyme system is essential component of fungal cell membrane which is responsible for the synthesis of ergosterol.
Dosage & Administration of Capsule :-Flugal 150mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).
Adults:
- Vaginal Candidiasis: 150 mg as a single dose.
- Oropharyngeal Candidiasis: 200 mg in 1st day followed by 100 mg daily for 14 days.
- Oesophageal Candidiasis: 200 mg in 1st day followed by 100 mg daily for 14-30 days.
- Tinea corporis/Tinea cruris/Tinea pedis/Other Tinea: 150 mg weekly for 4-6 weeks.
- Kerion: 50 mg daily for 20 days.
- Pityriasis versicolor: 400 mg as a single dose.
- Onychomycosis: 150 mg weekly for 12 months.
- Invasive candidal infections and cryptococcal infections (including meningitis): Orally or by IV infusion, 400 mg on first day then 200-400 mg daily.
- Prevention of cryptococcal meningitis: Orally or by IV infusion 200 mg daily.
- Prevention of fungal infections in immunocompromised patients: Orally or by IV infusion, 50-400 mg daily.
Child over 1 year-
- In Superficial Candidiasis: 1-2 mg/kg daily.
- In Systemic Candidiasis & Cryptococcal infection:3-6 mg/kg daily.
In serious life threatening infections upto 12 mg/kg daily has been given to children aged 5-13 years (Maximum 400 mg daily)
- 1 year: 9 kg: 1/2 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 Population-
Elderly patient: The normal dose should be used if there is no evidence of renal impairment.
Renal Impairment: No adjustment in single dose therapy is required. In multiple dose therapy of patients with renal impairment, normal doses should be given on days 1 and 2 of treatment and there after the dosage intervals should be modified as follows:
- Creatinine clearance (>41 ml/min): Dosage interval (hours) 24
- Creatinine clearance (21-40 ml/min): Dosage interval (hours) 48
- Creatinine clearance (10-20 ml/min): Dosage interval (hours) 72
- Patients receiving regular dialysis: One dose after every dialysis session
Children: Renal clearance in children may be proportionately more rapid than in adults and doses up to 12 mg/kg is recommended.
Side Effects of Capsule :-Flugal 150mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).
Flugal is generally well tolerated. The commonest side-efects associated Flugal are symptoms associated with the gastrointestinal tract; these include nausea, abdominal discomfort, diarrhoea and fatulence. Other adverse events such as rash are rarely encountered (Incidence less than 1%). In rare cases, as with other azoles, anaphylaxis has been reported.
Pregnancy & Lactation of Capsule :-Flugal 150mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).
Fluconazole adverse fetal efects have been seen in animals only at dose levels associated with maternal toxicity. These levels are many times in excess of those recommended for therapeutic use. There has been little use during human pregnancy. Accordingly, fuconazole should not be used in pregnancy or in women of child bearing potential unless adequate contraception is employed.
Therapeutic Class of Capsule :-Flugal 150mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).
Drugs for subcutaneous and mycoses
General Queries:
1.Which oral antifungal is safer in pregnancy?
Answer is:-Terbinafin **
Topical use korai best**
Khub besi dorkr na hole oral na deyai valo*
2:Fluconazole ki pregnancy te topical dewa jabe?
Answer is:
Topical Terbinafin best*for pregnancy pt.
3:Most common complications konta??
Age 70+ male Hypertensive( mild cardiomegaly) patient cap.flugal 50mg( As a Fluconazole) 2 tab daily morning a khassa tarpor thaka ee patient complain korsa dizziness & nausea hossa( চোখ মাথা ঘুরাচেছ সাথে বমি বমি ভাব হচ্ছে). Akhn ki medicine continue korba??
Answer is: 2 daily morning
Fluconazole er jonnoi hocche hoyto!Stop kre dkte pren!
Raiyyan Tahsan Date:19-01-2025 Sunday Time:-8-20-35 PM.
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