Fluconozale

[Kiwidi]

Does anyone know anything about the use of this anti-fungal ( fluconozale) that helps with the absorption of ibrutinib or venetoclax ? It seems like it means you can reduce the dosage by about 1/3. This is really important for those who are self funding. Some specialists are prescribing it here in NZ.

[AussieNeil Administrator]

Fluconozale, brand name: Diflucan, is not the kind of drug you want to use without medical supervision. There's the need in particular to have regular liver function checks. It interferes with quite a few different drugs in the way it presumably does with ibrutinib or venetoclax, increasing the incidence of side effects if the dose is not reduced. It's a pity that some specialists feel that they need to support its use so that their patients can avoid older and increasingly less effective older chemotherapy treatments.

Some extracts about the challenges of using flucnozale, with my emphasis, from medicalnewstoday.com/articl...

Important warnings

- Liver failure warning. This drug may cause you to develop liver failure. Your doctor may check your liver function with blood tests while you take this drug. If you develop liver failure from taking this drug, it’s usually reversible once you stop taking it.

- Skin rashes warning. This drug can cause a severe rash that can cause death. You should stop taking the drug if you develop any rashes.

- Irregular heart rhythm warning. This drug can change how your heart beats. This change puts you at risk for a life-threatening heart rhythm condition called torsades de pointes. Your risk of heart rhythm problems is higher if you were born with a certain heart rhythm condition, you have a low potassium level, or you take antipsychotic drugs or certain antidepressants.

- Adrenal gland problems. This drug can cause you to develop adrenal gland problems. Your adrenal gland produces hormones that affect many normal bodily functions. This problem may be reversible after stopping the drug.

- Fetal harm warning. This drug may cause harm to the fetus if taken during pregnancy. Talk with your doctor if you can get pregnant. You may need to use birth control to prevent pregnancy while taking this drug.

Drugs that should not be used with fluconazole

There are certain drugs that you should not use with fluconazole. When used with fluconazole, these drugs can cause dangerous effects in your body. Examples of these drugs include:

- Terfenadine. When used with fluconazole at doses of 400 mg or higher, this drug can cause a life-threatening heart rhythm condition called torsades de pointes.

- Pimozide, clarithromycin, erythromycin, ranolazine, lomitapide, donepezil, voriconazole, and quinidine. When used with fluconazole, these drugs can cause a life-threatening heart rhythm condition called torsades de pointes.

Drugs that increase the risk of side effects

Taking fluconazole with certain drugs raises your risk of side effects from those drugs.

(see full list per link above)

Allergy warning

This drug can cause a severe allergic reaction.

Warnings for people with certain health conditions

:

- For people with kidney disease: If you have kidney disease or a history of kidney disease, your kidneys may not be able to remove this drug from your body like they should. This may increase the levels of fluconazole in your body and cause more side effects. This drug may also make existing kidney disease worse.

- People with liver problems: Fluconazole can cause liver problems. If you already have liver problems, talk with your healthcare professional before taking this drug.

- People with high blood sugar levels: The oral suspension form of this drug contains sucrose, a kind of sugar. You shouldn’t use this form of the drug if you have a condition that increases your blood sugar level. Talk with your doctor before using this drug if you have high blood sugar levels or a condition, such as diabetes, which can cause high blood sugar levels.

- People with abnormal heart rhythms: Using fluconazole can affect your heart rhythm. If you already have an abnormal heart rhythm, taking fluconazole may lead to dangerous heart rhythm problems.

- People with certain conditions that lower immunity: If you have certain conditions that lower your immunity, such as cancer, human immunodeficiency virus infection (HIV), or acquired immunodeficiency syndrome (AIDS) you’re more likely to get a rash from fluconazole. Your doctor will monitor you for a rash and peeling skin.

It will be interesting to hear user experiences.

Neil

[Shepherd777 in reply to AussieNeil]

My wife during her Venetoclax treatments was prescribed (not by her CLL doctor) one Fluconozale pill for a yeast infection. She became very ill within four hours and began vomiting plus diarrhea. That med was immediately put on her no no list.

[MrMidnight in reply to Shepherd777]

Given it is claimed that Fluconazole raises the concentration of Venetoclax in plasma, an adverse reaction to what is possibly an overdose of Venetoclax would not be surprising.

[Shepherd777 in reply to MrMidnight]

My wife had not reached the full dose for Venetoclax when this happened. She was half there when she took the fluconazole.

[MrMidnight in reply to Shepherd777]

That's interesting. Unfortunately, no one knows exactly how much Fluconazole raises the level of Venetoclax in plasma.

I have been told it is somewhere between two and five times. So it is possible even with a relatively low dose of Venetoclax your wife could have been getting too much V.

Or it may have just been a reaction to Fluconazole of course.

[Kiwidi in reply to AussieNeil]

Thank you Neil. Hopefully someone in NZ who is using it will comment?

[noeagaman]

I have been taking Fluconazole ever since I started FCR 5 years ago. I developed thrush ding FCR and it is still a problem to this day. I am still on one pill per day.

Chris