Candinil
Generic Name
Fluconazole
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| candinil 200 mg capsule | ৳ 25.00 | ৳ 100.00 |
Description
Overview of the medicine
Candinil 200 mg Capsule is an antifungal medication used to treat a variety of fungal and yeast infections. It belongs to the azole class of antifungals and works by stopping the growth of fungi.
Uses & Indications
Dosage
Adults
Dosage varies by indication. For vaginal candidiasis: 150 mg single oral dose. For oropharyngeal candidiasis: 50-100 mg once daily for 7-14 days. For esophageal candidiasis: 100-200 mg once daily for 14-30 days. For systemic candidiasis/cryptococcal meningitis: Initial dose 400 mg, then 200-400 mg once daily. Prophylaxis: 50-400 mg once daily.
Elderly
No dosage adjustment is typically required in elderly patients with normal renal function. For patients with renal impairment, dosage adjustment is necessary.
Renal_impairment
For creatinine clearance 21-50 mL/min, administer 50% of the recommended dose. For creatinine clearance ≤ 20 mL/min, administer 25% of the recommended dose. Hemodialysis patients should receive a full dose after each dialysis session.
How to Take
Candinil capsules can be taken orally, with or without food. It is advisable to take the medicine at the same time each day.
Mechanism of Action
Fluconazole inhibits fungal cytochrome P450-dependent 14-alpha-demethylation of lanosterol, an essential step in fungal ergosterol biosynthesis. This leads to an accumulation of 14-alpha-methyl sterols and a decrease in ergosterol, thereby impairing fungal cell membrane integrity and inhibiting fungal growth.
Pharmacokinetics
Onset
Clinical effects typically observed within a few days to a week, depending on the infection type and severity.
Excretion
Mainly renal excretion, with approximately 80% of the administered dose appearing unchanged in urine. Renal clearance is proportional to creatinine clearance.
Half life
Approximately 20-50 hours (average 30 hours), allowing for once-daily dosing for many indications.
Absorption
Well absorbed orally, with bioavailability greater than 90%. Peak plasma concentrations are achieved within 1-2 hours.
Metabolism
Minimal hepatic metabolism; primarily excreted unchanged.
Side Effects
Contraindications
- Hypersensitivity to fluconazole or other azole antifungals, or any excipients in the formulation.
- Co-administration with drugs known to prolong the QT interval and are metabolized by CYP3A4 (e.g., terfenadine, cisapride, astemizole, pimozide, quinidine, erythromycin) is contraindicated.
Drug Interactions
Warfarin
Increased prothrombin time (PT), increased risk of bleeding.
Phenytoin
Increased phenytoin levels; monitor and adjust dose.
Rifampicin
Decreased fluconazole levels; consider increasing fluconazole dose.
Cyclosporine
Increased cyclosporine levels; monitor renal function and cyclosporine levels.
Oral Hypoglycemics (sulfonylureas)
Increased blood glucose lowering effect; monitor blood sugar.
Statins (e.g., simvastatin, atorvastatin)
Increased statin levels, increased risk of myopathy/rhabdomyolysis.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
In case of overdose, supportive measures and symptomatic treatment are recommended. Gastric lavage may be appropriate, and fluconazole is largely excreted in the urine, with a three-hour hemodialysis session decreasing plasma levels by approximately 50%.
Pregnancy & Lactation
Pregnancy Category D for prolonged/high-dose use, Category C for single-dose use. Avoid during pregnancy unless the potential benefit outweighs the potential risk to the fetus. Fluconazole is excreted in breast milk; therefore, caution should be exercised when administered to a nursing woman.
Side Effects
Contraindications
- Hypersensitivity to fluconazole or other azole antifungals, or any excipients in the formulation.
- Co-administration with drugs known to prolong the QT interval and are metabolized by CYP3A4 (e.g., terfenadine, cisapride, astemizole, pimozide, quinidine, erythromycin) is contraindicated.
Drug Interactions
Warfarin
Increased prothrombin time (PT), increased risk of bleeding.
Phenytoin
Increased phenytoin levels; monitor and adjust dose.
Rifampicin
Decreased fluconazole levels; consider increasing fluconazole dose.
Cyclosporine
Increased cyclosporine levels; monitor renal function and cyclosporine levels.
Oral Hypoglycemics (sulfonylureas)
Increased blood glucose lowering effect; monitor blood sugar.
Statins (e.g., simvastatin, atorvastatin)
Increased statin levels, increased risk of myopathy/rhabdomyolysis.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
In case of overdose, supportive measures and symptomatic treatment are recommended. Gastric lavage may be appropriate, and fluconazole is largely excreted in the urine, with a three-hour hemodialysis session decreasing plasma levels by approximately 50%.
Pregnancy & Lactation
Pregnancy Category D for prolonged/high-dose use, Category C for single-dose use. Avoid during pregnancy unless the potential benefit outweighs the potential risk to the fetus. Fluconazole is excreted in breast milk; therefore, caution should be exercised when administered to a nursing woman.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture.
Availability
Pharmacies nationwide
Approval Status
Approved by major regulatory authorities
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of fluconazole for various fungal infections. Ongoing post-marketing surveillance continues to monitor its long-term effects and rare adverse events.
Lab Monitoring
- Liver function tests (LFTs) should be monitored periodically, especially in patients with underlying liver disease or those on prolonged therapy.
- Renal function tests, particularly in elderly patients or those with pre-existing renal impairment.
Doctor Notes
- Counsel patients on the importance of completing the full course of therapy to prevent recurrence and resistance.
- Monitor liver function tests, especially in patients on prolonged therapy or with pre-existing liver conditions.
- Be aware of significant drug interactions, particularly with QT-prolonging agents and CYP3A4 substrates.
Patient Guidelines
- Complete the full course of medication as prescribed by your doctor, even if your symptoms improve.
- Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements.
- Report any severe or persistent side effects, especially unusual tiredness, yellowing of skin/eyes, or dark urine, as these could be signs of liver problems.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Candinil may cause dizziness or seizures in some individuals. Patients should be cautioned about operating machinery or driving until they know how fluconazole affects them.
Lifestyle Advice
- Maintain good personal hygiene to prevent recurrence of fungal infections.
- Avoid sharing personal items like towels and clothing.
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