Diflucan Side Effects

Generic Name: fluconazole

Note: This page contains information about the side effects of fluconazole. Some of the dosage forms included on this document may not apply to the brand name Diflucan.

Not all side effects for Diflucan may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to fluconazole: oral capsule, oral powder for suspension, oral tablet

In addition to its needed effects, some unwanted effects may be caused by fluconazole (the active ingredient contained in Diflucan). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking fluconazole:

Rare
  • Abdominal or stomach pain
  • chills
  • clay-colored stools
  • cough
  • dark urine
  • diarrhea
  • difficulty with swallowing
  • dizziness
  • fast heartbeat
  • fever
  • general feeling of tiredness or weakness
  • headache
  • hives, itching, or skin rash
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • light-colored stools
  • loss of appetite
  • nausea and vomiting
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • stomach pain, continuing
  • tightness in the chest
  • unpleasant breath odor
  • unusual tiredness or weakness
  • upper right abdominal or stomach pain
  • vomiting of blood
  • yellow eyes and skin
Incidence not known
  • Black, tarry stools
  • blistering, peeling, or loosening of the skin
  • chest pain or discomfort
  • convulsions
  • decreased urine
  • dry mouth
  • fainting
  • hoarseness
  • increased thirst
  • irregular or slow heart rate
  • joint or muscle pain
  • loss of bladder control
  • lower back or side pain
  • mood changes
  • muscle pain or cramps
  • muscle spasm or jerking of all extremities
  • numbness or tingling in the hands, feet, or lips
  • painful or difficult urination
  • pale skin
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • sore throat
  • sores, ulcers, or white spots in the mouth or on the lips
  • sudden loss of consciousness
  • swollen glands
  • unusual bleeding or bruising

If any of the following symptoms of overdose occur while taking fluconazole, get emergency help immediately:

Symptoms of overdose
  • Fearfulness, suspiciousness, or other mental changes
  • seeing, hearing, or feeling things that are not there

Some of the side effects that can occur with fluconazole may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common
  • Acid or sour stomach
  • belching
  • change in taste or bad, unusual, or unpleasant (after) taste
  • heartburn
  • indigestion
  • stomach discomfort or upset
Incidence not known
  • Hair loss or thinning of the hair

For Healthcare Professionals

Applies to fluconazole: intravenous solution, oral powder for reconstitution, oral tablet

General

This drug was generally well tolerated. Changes in renal and hematological function test results and hepatic abnormalities reported during therapy with this and comparative agents in some patients, primarily those with serious underlying diseases (e.g., AIDS, cancer); clinical significance and relationship to therapy unclear.

During clinical trials of single-dose therapy, side effects possibly related to therapy were reported in 26% of patients using this drug and 16% of patients using active comparative agents. The most common side effects reported in patients receiving a single 150 mg dose of this drug for vaginitis were headache, nausea, and abdominal pain. Most side effects were of mild to moderate severity.

During clinical trials of multiple-dose therapy, side effects were reported in 16% of patients. Therapy discontinuation occurred in 1.5% and 1.3% of patients due to adverse clinical events and laboratory test abnormalities, respectively. Clinical side effects were reported more often in HIV-infected patients than in non-HIV-infected patients (21% versus 13%), but the patterns in both groups were similar.[Ref]

Nervous system

Rare cases of seizures have been reported, but a causal relationship was difficult to establish, since some of these patients had cryptococcal meningitis or severe underlying disease. Nonetheless, at least 1 case of seizure following a 100 mg oral dose has been reported.

Seizures, dizziness, paresthesia, somnolence, tremor, and vertigo have also been reported during postmarketing experience.[Ref]

Very common (10% or more): Headache (up to 13%)
Uncommon (0.1% to 1%): Seizures, dizziness, paresthesia, somnolence, vertigo, visual field defect, taste perversion, hyperkinesia, hypertonia
Rare (less than 0.1%): Tremor
Frequency not reported: Dysesthesias[Ref]

Gastrointestinal

Very common (10% or more): Nausea, abdominal pain, diarrhea, vomiting
Common (1% to 10%): Dyspepsia
Uncommon (0.1% to 1%): Constipation, flatulence, loose stools, dry mouth
Frequency not reported: General abdominal discomfort[Ref]

Dry mouth, dyspepsia, and vomiting have also been reported during postmarketing experience.[Ref]

Hepatic

Fatal hepatic reactions have occurred primarily in patients with serious underlying medical conditions (primarily AIDS or malignancy) and often taking multiple concomitant medications. One reported patient with AIDS experienced acute hepatic necrosis and hepatic failure about 3 weeks after starting this drug.

Transient hepatic reactions have been reported in patients with no other identifiable risk factors. Liver function returned to baseline after stopping this drug.

Serum transaminase elevations (greater than 8 times the upper limit of normal [8 x ULN]; about 1%) and statistically significant increases in AST have been reported. Serum transaminase elevations have been reported primarily in patients with serious underlying medical conditions (primarily AIDS or malignancy) and often taking multiple concomitant medications, including agents known to be hepatotoxic.

Transaminase elevations greater than 2 to 3 x ULN have also been reported.

Cholestasis, hepatocellular damage, and hepatocellular necrosis have also been reported during postmarketing experience.[Ref]

Very common (10% or more): Increased ALT, increased AST
Uncommon (0.1% to 1%): Serum transaminase elevations, cholestasis, jaundice, increased bilirubin
Rare (less than 0.1%): Serious hepatic reactions, hepatic toxicity (including fatalities), hepatic failure, hepatocellular necrosis, hepatitis, hepatocellular damage
Frequency not reported: Hepatic reactions (ranging from mild transient transaminase elevations to clinical hepatitis, fulminant hepatic failure [including fatalities]), transient hepatic reactions (including hepatitis, jaundice), elevated liver function tests (transient and asymptomatic), cholestatic jaundice, fatal hepatic necrosis, increased plasma levels of hepatic enzymes[Ref]

Dermatologic

Reversible alopecia has been associated with long-term (2 months or longer) therapy.

In patients with serious underlying diseases (primarily AIDS and malignancy), exfoliative skin disorders have resulted in a fatal outcome.

Acute generalized exanthematous pustulosis, drug eruption, increased sweating, exfoliative skin disorders (including Stevens-Johnson syndrome, toxic epidermal necrolysis), and alopecia have also been reported during postmarketing experience.[Ref]

Very common (10% or more): Rash
Common (1% to 10%): Maculopapular erythema
Uncommon (0.1% to 1%): Pruritus, genital pruritus, erythematous rash, dry skin, abnormal skin odor, urticaria, herpes simplex, drug eruption, increased sweating
Rare (less than 0.1%): Angioedema, exfoliative skin disorders (including Stevens-Johnson syndrome, toxic epidermal necrolysis), alopecia, acute generalized exanthematous pustulosis, exfoliative dermatitis
Frequency not reported: Reversible alopecia, exfoliative skin disorders (including fatalities)[Ref]

Metabolic

Very common (10% or more): Increased blood alkaline phosphatase
Uncommon (0.1% to 1%): Hypokalemia, anorexia, decreased appetite
Rare (less than 0.1%): Hypercholesterolemia, hypertriglyceridemia[Ref]

Hypercholesterolemia, hypertriglyceridemia, and hypokalemia have also been reported during postmarketing experience.[Ref]

Hypersensitivity

Rare cases of exfoliative dermatitis and ulcerative eruptions consistent with Stevens-Johnson syndrome have been reported in association with hypersensitivity reactions.

A 52-year-old female experienced a fixed drug eruption (FDE) when administered a single 400 mg oral dose for extensive pityriasis versicolor. Within 12 hours, she noticed 3 oval, painful, eroded, pigmented patches over her trunk with diameters of 3 to 4 cm and erythematous halos. A clinical diagnosis of FDE due to drug therapy was made. The FDE was confirmed when the patient was rechallenged with a 25 mg oral dose.[Ref]

Rare (less than 0.1%): Anaphylactic reaction, anaphylaxis
Frequency not reported: Hypersensitivity reactions (including generalized edema, stridor, hypotension, exfoliative dermatitis, ulcerative eruptions), fixed drug eruption
Postmarketing reports: Anaphylaxis (including angioedema, face edema, pruritus)[Ref]

Cardiovascular

Most reports of QT interval prolongation and torsades de pointes involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications that may have been contributory.

An 11-year-old male with neurofibromatosis-1 presented to the hospital in septic shock secondary to a perforated gastric volvulus. After initial stabilization, the patient underwent total gastrectomy and multiple peritoneal lavages. Culture of peritoneal fluid showed infection with Candida albicans. Therapy was started with fluconazole (the active ingredient contained in Diflucan) 150 mg IV every 12 hours. After starting this drug, the patient developed QT prolongation and complex ventricular arrhythmia. The drug was discontinued. Over the subsequent 36-hours, the patient remained in sinus rhythm except for one brief run of ventricular bigeminy. An ECG recorded 5 months after admission (and about 4 months after cessation of all QT-prolonging medications) showed sinus rhythm with normal heart rate and corrected QT interval.

QT prolongation and torsade de pointes have also been reported during postmarketing experience.[Ref]

Rare (less than 0.1%): QT prolongation, torsade de pointes
Frequency not reported: Prolongation of the QT interval on the ECG, palpitations, complex ventricular arrhythmia[Ref]

Hematologic

Anemia, eosinophilia, leukopenia, neutropenia, and thrombocytopenia have been reported, often in patients with severe deep fungal infections or underlying disease.

Spontaneous reports of anemia were more frequent in patients 65 years of age or older than in those between 12 and 65 years of age; however, there is a natural increase in the incidence of anemia in the elderly. A causal relationship to drug exposure could not be determined.

Anemia, leukopenia, neutropenia, agranulocytosis, and thrombocytopenia have also been reported during postmarketing experience.[Ref]

Uncommon (0.1% to 1%): Anemia
Rare (less than 0.1%): Leukopenia, neutropenia, agranulocytosis, thrombocytopenia
Frequency not reported: Eosinophilia[Ref]

Other

Uncommon (0.1% to 1%): Thirst, fatigue, malaise, pain, rigors, asthenia, fever, flushing, hot flushes
Rare (less than 0.1%): Face edema
Frequency not reported: Infection due to resistant microorganisms[Ref]

Fever, asthenia, fatigue, and malaise have also been reported during postmarketing experience.[Ref]

Musculoskeletal

Uncommon (0.1% to 1%): Back pain, myalgia
Frequency not reported: Joint pain, finger stiffness[Ref]

Myalgia has also been reported during postmarketing experience.[Ref]

Psychiatric

Uncommon (0.1% to 1%): Insomnia, nervousness

Insomnia has also been reported during postmarketing experience.

Renal

Uncommon (0.1% to 1%): Polyuria, renal pain, changes in renal function tests
Frequency not reported: Membranous nephropathy
Postmarketing reports: Acute renal failure[Ref]

A 58-year-old female with a history of hypertension and cervical cancer experienced membranous nephropathy coincident with this drug. The patient presented with increasing generalized edema accompanied by nausea and indigestion for 3 weeks. Clinical findings showed the patient had stage I membranous nephropathy. At initial presentation, the patient's medication history included amlodipine, hydrochlorothiazide, metoclopramide, and levosulpiride. She did not admit to taking fluconazole. Five months after the initial presentation, the patient returned with reports of increasing pedal edema. At that point, the patient admitted to taking this drug once a week for tinea pedis. The patient went into complete remission when the drug was stopped.

Spontaneous reports of acute renal failure were more frequent in patients 65 years of age or older than in those between 12 and 65 years of age; however, there is a natural increase in the incidence of renal failure in the elderly. A causal relationship to drug exposure could not be determined.[Ref]

Genitourinary

Uncommon (0.1% to 1%): Intermenstrual bleeding, dysmenorrhea, leukorrhea, menorrhagia, uterine spasm, vaginal disorders, female sexual dysfunction

Respiratory

Uncommon (0.1% to 1%): Pharyngitis
Frequency not reported: Respiratory disorders[Ref]

Ocular

Uncommon (0.1% to 1%): Abnormal vision

References

1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

2. Grant SM, Clissold SP "Fluconazole: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial and systemic mycoses." Drugs 39 (1990): 877-916

3. Cerner Multum, Inc. "Australian Product Information." O 0

4. "Product Information. Diflucan (fluconazole)." Roerig Division, New York, NY.

5. Saag MS, Powderly WG, Cloud GA, et al "Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis." N Engl J Med 326 (1992): 83-9

6. Inman W, Pearce G, Wilton L "Safety of fluconazole in the treatment of vaginal candidiasis - a prescription-event monitoring study, with special reference to the outcome of pregnancy." Eur J Clin Pharmacol 46 (1994): 115-8

7. Gupta AK, Ryder JE "The use of oral antifungal agents to treat onychomycosis." Dermatol Clin 21 (2003): 469-79, vi

8. Phillips RJ, Watson SA, McKay FF "An open multicentre study of the efficacy and safety of a single dose of fluconazole 150 mg in the treatment of vaginal candidiasis in general practice." Br J Clin Pract 44 (1990): 219-22

9. Thompson GR 3rd, Cadena J, Patterson TF "Overview of antifungal agents." Clin Chest Med 30 (2009): 203-15, v

10. Robinson PA, Knirsch AK, Joseph JA "Fluconazole for life-threatening fungal infections in patients who cannot be treated with conventional antifungal agents." Rev Infect Dis 12 (1990): s349-63

11. Bozzette SA, Larsen RA, Chiu J, et al "A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome." N Engl J Med 324 (1991): 580-4

12. Holechek MJ "Medication review: fluconazole." ANNA J 18 (1991): 585-6

13. Goodman JL, Winston DJ, Greenfield RA, et al "A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation." N Engl J Med 326 (1992): 845-51

14. Morrow JD "Fluconazole: a new triazole antifungal agent." Am J Med Sci 302 (1991): 129-32

15. Vincent-Ballereau FN, Patey ON, Lafaix C "Fluconazole: review and situation among antifungal drugs in the treatment of opportunistic mycoses of human immuno-deficiency virus infections." Pharm Weekbl Sci 13 (1990): 45-57

16. Ikemoto H "A clinical study of fluconazole for the treatment of deep mycoses." Diagn Microbiol Infect Dis 12 (1989): s239-47

17. De Wit S, Clumeck N "Fluconazole in the treatment of fungal infections associated with AIDS." Infection 17 (1989): 121-3

18. Gearhart MO "Worsening of liver function with fluconazole and review of azole antifungal hepatotoxicity." Ann Pharmacother 28 (1994): 1177-81

19. Franklin IM, Elias E, Hirsch C "Fluconazole-induced jaundice." Lancet 336 (1990): 565

20. Wells C, Lever AM "Dose-dependent fluconazole hepatotoxicity proven on biopsy and rechallenge ." J Infect 24 (1992): 111-2

21. Munoz P, Moreno S, Berenguer J, et al "Fluconazole-related hepatotoxicity in patients with acquired immunodeficiency syndrome." Arch Intern Med 151 (1991): 1020-1

22. Jacobson MA, Hanks DK, Ferrell LD "Fatal acute hepatic necrosis due to fluconazole." Am J Med 96 (1994): 188-90

23. Nightingale SD, Cal SX, Peterson DM, et al "Primary prophylaxis with fluconazole against systemic fungal infections in HIV-positive patients." AIDS 6 (1992): 191-4

24. Guillaume MP, Deprez C, Cogan E "Subacute mitochondrial liver disease in a patient with AIDS: possible relationship to prolonged fluconazole administration." Am J Gastroenterol 91 (1996): 165-8

25. Craig TJ, Peralta F, Boggavarapu J "Desensitization for fluconazole hypersensitivity." J Allergy Clin Immunol 98 (1996): 845-6

26. Shear NH "Alopecia associated with fluconazole therapy." Ann Intern Med 125 (1996): 153

27. Pappas PG, Kauffman CA, Perfect J, Johnson PC, Mckinsey DS, Bamberger DM, Hamill R, Sharkey PK, Chapman SW, Sobel JD "Alopecia associated with fluconazole therapy." Ann Intern Med 123 (1995): 354-7

28. Goldsmith LA "Alopecia associated with fluconazole therapy." Ann Intern Med 125 (1996): 153

29. Neuhaus G, Pavic N, Pletscher M "Anaphylactic reaction after oral fluconazole." Br Med J 302 (1991): 1341

30. Gupta R, Thami GP "Fixed drug eruption caused by itraconazole: Reactivity and cross reactivity." J Am Acad Dermatol 58 (2008): 521-522

31. Gussenhoven MJ, Haak A, Peereboom-Wynia JD, van Wout JW "Stevens-Johnson syndrome after fluconazole." Lancet 338 (1991): 120

32. Abbott M, Hughes DL, Patel R, Kinghorn GR "Angio-oedema after fluconazole." Lancet 338 (1991): 633

33. Beecker J, Colantonio S "Fixed drug eruption due to fluconazole." CMAJ 184 (2012): 675

34. McMahon JH, Grayson ML "Torsades de pointes in a patient receiving fluconazole for cerebral cryptococcosis." Am J Health Syst Pharm 65 (2008): 619-23

35. Esch JJ, Kantoch MJ "Torsades de pointes ventricular tachycardia in a pediatric patient treated with fluconazole." Pediatr Cardiol 29 (2007): 210-3

36. Mercurio MG, Elewski BE "Thrombocytopenia caused by fluconazole - reply." J Am Acad Dermatol 35 (1996): 284

37. Kalivas J "Thrombocytopenia caused by fluconazole." J Am Acad Dermatol 35 (1996): 284

38. Pappas PG, Kauffman CA, Sobel JD "Alopecia associated with fluconazole therapy." Ann Intern Med 125 (1996): 153-4

39. Mercurio MG, Elewski BE "Thrombocytopenia caused by fluconazole therapy." J Am Acad Dermatol 32 (1995): 525-6

40. Agarwal A, Sakhuja V, Chugh KS "Fluconazole-induced thrombocytopenia." Ann Intern Med 113 (1990): 899

41. Shin GT, Yim H, Park J, Kim H "Membranous nephropathy associated with fluconazole treatment." Am J Kidney Dis 49 (2007): 318-22

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

Hide
(web3)