Alopecia Associated with Fluconazole Therapy

  title={Alopecia Associated with Fluconazole Therapy},
  author={Peter G. Pappas and Carol A. Kauffman and John R. Perfect and Philip C. Johnson and David S. McKinsey and David M. Bamberger and Richard J. Hamill and Patricia Kay Sharkey and Stanley W. Chapman and Jack D. Sobel},
  journal={Annals of Internal Medicine},
Fluconazole is a triazole compound with broad-spectrum antifungal activity; it was approved by the Food and Drug Administration in 1990 for the treatment of cryptococcal meningitis and mucosal and systemic candidiasis [1]. It has been used extensively in the United States and other countries to treat proven and suspected infection caused by Candida species and Cryptococcus neoformans [2, 3] and as prophylaxis in neutropenic patients [4], recipients of bone marrow and solid organ transplants [5… 

Comparison of Oral Fluconazole and Itraconazole for Progressive, Nonmeningeal Coccidioidomycosis

The findings from Mycoses Study Group Protocol 20, a comparative trial sponsored by the National Institute of Allergy and Infectious Diseases that compares two antifungal agents, fluconazole and itraconazole, in the treatment of coccidioidomycosis, are presented.

Fluconazole for the management of invasive candidiasis: where do we stand after 15 years?

Importantly 15 years after its introduction in the antifungal armamentarium, fluconazole is still a first line treatment option in several cases of invasive candidiasis and its prophylactic use should however be limited to selected high-risk patients to limit the risk of emergence of azole-resistant strains.

Voriconazole: How to Use This Antifungal Agent and What to Expect.

Drawbacks to the use of voriconazole are that it has unpredictable, nonlinear pharmacokinetics with extensive interpatient and intrapatient variation in serum levels, and, as a result, therapeutic drug monitoring is essential when using this agent.

Antifungal agents. Part II. The azoles.

  • C. Terrell
  • Medicine, Biology
    Mayo Clinic proceedings
  • 1999
Fluconazole and itraconazole have replaced ketoconazole as the therapy of choice for nonmeningeal, non-life-threatening cases of histoplasmosis, blastomycosis, and paracoccidioidomycotic cases and is effective in patients with cryptococcosis and coccidioillosis, including those with meningitis.

Adverse Effects Associated with Long-Term Administration of Azole Antifungal Agents

Azole antifungals are first-line options in the prophylaxis and treatment of invasive fungal infections and have been associated with peripheral neuropathies, and itraconazole and voriconazole with pancreatitis.

Treatment of blastomycosis with higher doses of fluconazole. The National Institute of Allergy and Infectious Diseases Mycoses Study Group.

  • P. PappasR. Bradsher W. Dismukes
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 1997
It is concluded that fluconazole at daily doses of 400 to 800 mg for at least 6 months is effective therapy for non-life-threatening blastomycosis.

Fluconazole Therapy for Histoplasmosis

It is concluded that fluconazole therapy for histoplasmosis is only moderately effective and should be reserved for patients who cannot take itraconazole.

Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole.

  • C. KauffmanP. Pappas W. Dismukes
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 1996
Fluconazole is only modestly effective for treatment of sporotrichosis and should be considered second-line therapy for the occasional patient who is unable to take itraconazole.

Clinical safety and tolerability issues in use of triazole derivatives in management of fungal infections

Clinicians treating patients with triazoles should closely follow them, monitor pertinent laboratory tests, and consider measuring drug levels as needed, to ensure that patients are optimally treated with the least amount of toxicity possible.

Endemic mycoses: a treatment update.

Itraconazole is the treatment of choice for non-life-threatening Histoplasma capsulatum or Blastomyces dermatitidis infections occurring in immunocompetent individuals and is the most efficient secondary prophylaxis of histoplasmosis in AIDS patients.



A Randomized Trial Comparing Fluconazole with Amphotericin B for the Treatment of Candidemia in Patients without Neutropenia

A multicenter randomized trial that compared amphotericin B with fluconazole as treatment for candidemia, with the most common diagnoses being renal failure, nonhematologic cancer, and gastrointestinal disease.

Fluconazole. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial and systemic mycoses.

The promising clinical response of patients with various forms of candidiasis or cryptococcosis--together with convenient administration regimens--recommends fluconazole as a useful addition to currently available systemic antifungal therapies, in particular for the treatment of mycoses in patients with AIDS.

Fluconazole therapy for coccidioidal meningitis. The NIAID-Mycoses Study Group.

Fluconazole therapy is often effective in suppressing coccidioidal meningitis, and response rates were similar for patients with and without previous therapy, for patients without and without concomitant HIV infection, and for patientswith and without pre-existing hydrocephalus.

Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. The NIAID Mycoses Study Group and the AIDS Clinical Trials Group.

Fluconazole is an effective alternative to amphotericin B as primary treatment of cryptococcal meningitis in patients with AIDS and single-drug therapy with either drug is most effective in patients who are at low risk for treatment failure.

Treatment of blastomycosis with fluconazole: a pilot study. The National Institute of Allergy and Infectious Diseases Mycoses Study Group.

  • P. PappasR. Bradsher W. Dismukes
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 1995
It is concluded that fluconazole (200 mg to 400 mg daily) given for at least 6 months is moderately effective treatment for blastomycosis.

A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation.

Prophylactic administration of fluconazole to recipients of bone marrow transplants reduces the incidence of both systemic and superficial fungal infections.

Fluconazole Prophylaxis of Fungal Infections in Patients with Acute Leukemia: Results of a Randomized Placebo-Controlled, Double-Blind, Multicenter Trial

There is currently no uniformly accepted or proven approach for prevention of fungal infections in neutropenic patients with acute leukemia and fluconazole is a new triazole antifungal agent with activity against many common fungal pathogens causing infection in patients with severe liver disease.

New Oral Treatments for Dermatophytosis

  • R. Hay
  • Medicine
    Annals of the New York Academy of Sciences
  • 1988
Evaluating the newest orally active antifungals in the light of these comments finds a need for alternative methods of therapy in order to achieve better treatment responses in onychomycosis, in dry-type T. rubrum infections, and in certain other dermatophytoses.

Pharmacology and toxicity of high-dose ketoconazole

Neither concentration in serum, toxicity, nor outcome correlated with dose, calculated in milligrams per kilogram at the fixed doses (400-mg increments) under study, suggesting that individual drug disposition was not an important factor in outcome or toxicity.

High-dose ketoconazole therapy and adrenal and testicular function in humans.

Patients receiving ketoconazole should be considered potentially unable to mount an adrenal stress response and may require testosterone supplementation.