How should I treat thrush (candida), when I have genital herpes?
Thrush is also known as candidiasis or a yeast infection.
It is widely thought that that using a thrush cream to treat a yeast infection can make a genital herpes outbreak worse. So if you have both at once, it is best to use a pill (oral medication) to get rid of thrush: you can buy fluconazole pills (brand name Difflucan or Canesten) at the chemist or it can be prescribed by your doctor. One dose should be enough.
First of all, it may be an idea to make sure that thrush is actually what you have. American studies show that two-thirds of women who buy over-the-counter thrush treatments don’t have a yeast infection at all.
Problems may also be caused by ‘jock itch’ – another itchy rash, often in the groin area that is usually caused by fungus infections called tinea. It is treated with anti-fungal cream, but tablets are sometimes used.
What is thrush like?
In women, the symptoms usually start with itch all over the vulva the outside part of the genitals. If not treated, it can become painful and swollen. You might notice a thick, white ‘cottage cheese’ discharge or a thin, watery white one.
In men, skin in the genital area may be sore and itchy, particularly under the foreskin.
How to tell the difference between a herpes outbreak and thrush?
Typically, a recurrence of genital herpes is one-sided, that means you will have the symptoms only on the left (or the right) not spread across the whole area. And a recurrence of genital herpes will cover an area of less than a 50p piece. Itch may be a symptom, but not necessarily. No discharge.
Thrush affects the whole area – and the itch is the main symptom you will notice, along with the white discharge. This white discharge is what gives the fungus its medical name of Candida albicans.
More about thrush
It is common. It is a fungus that lives with us. Virgins can get it. It can be treated but it is ‘incurable’. (And I use ‘incurable’ in the sense that our bodies can deal with it, but there is no medication to remove it completely so it can ‘just come back’.)
Although you don’t catch it in the first place (you just ‘develop it’), it is possible to pass thrush to a partner and (if he or she is not treated) you can catch it back again. So sexual health clinics will give you treatment for your partner to take at the same time. Men tend to be affected by thrush less than women, but along with jock itch it can cause problems for people who work in fixed positions for long periods without the opportunity for exercise and air circulation – such as lorry and bus drivers. Both infections prefer warm, damp environments, so loose fitting clothes and cotton underwear that breathes are best. Avoid wearing tights in hot weather.
Thrush is one of the many (two dozen or so) differential diagnoses that a well-informed doctor will consider if a swab test for herpes simplex is negative.
You can read a more full account of thrush: Feeling fungal? Not thrush again!
Fixed drug eruption resulting from fluconazole use: a case report
Author informationArticle notesCopyright and License informationDisclaimer
1Department of Health Sciences, Simon Fraser University, Burnaby, Canada V5A 1S6
2Skin Research Center, Shaheed Beheshti University of Medical Sciences and Health Services, Tehran, Iran
Received Nov 27; Accepted Jan
Copyright © licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC.
Fluconazole is a widely used antifungal agent with a possible side effect of fixed drug eruption. However, this adverse drug effect is absent from the reported list of possible side effects of fluconazole. We are presenting a rare case in our report.
A year-old Iranian woman developed fixed drug eruptions on different sites of her body after taking five doses of fluconazole to treat vaginal candidiasis. A positive patch test, positive oral challenge test and skin biopsy were all found to be consistent with fixed drug eruption.
Fluconazole is a widely prescribed drug, used mainly to treat candidiasis. Fixed drug eruption as a possible side effect of Fluconazole is not well known and thus, the lesions may be misdiagnosed and mistreated. Based on our findings, which are consistent with a number of other practitioners, we recommend adding fixed drug eruption to the list of possible side effects of fluconazole.
Fluconazole (Diflucan®) is a broadly used bis-triazole antifungal agent. It functions mainly by inhibiting cytochrome Pa-demethylase (PDM), which in turn, prevents the conversion of lanosterol to ergosterol in the sterol biosynthesis pathway. Fluconazole seems to have a superior selectivity for fungus compared to human Penzymes . It is used to treat vaginal, oropharyngeal, and esophageal candidiasis; additionally, it is used to treat cryptococcal meningitis and prevent fungal infections in immunocompromised patients. In some literature, fluconazole has proven to be effective for treatment of Candida urinary tract infections, peritonitis, and systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia . The body clears fluconazole primarily by renal excretion. Accordingly, the dosage should be reduced in proportion to any reduction in kidney function. In general, the body tolerates fluconazole quite well. Still, there are commonly observed adverse events such as nausea, vomiting and elevations in liver function tests. Less common side effects are headaches, dizziness, diarrhea, stomach pain, heartburn, change in ability to taste food, an upset stomach, extreme fatigue, appetite loss, pain in the right upper quadrant, jaundice, dark urine, pale stools, flu-like symptoms and seizures. Observed hypersensitivity reactions are anaphylactic reactions, angioedema and facial edema, pruritus, urticaria, erythematous or maculopapular rash and exfoliative skin reactions, including Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis .
Fixed drug eruption (FDE) is characterized by single or multiple skin lesions that occur at the same site each time a drug is administered. However, the number and size of sites may increase after each exposure. Lesions are usually round or oval and well defined. Swelling and redness of skin are typically seen within 30 minutes to eight hours after exposure. Lesions are more commonly seen in the extremities, genital areas and perianal areas, and may also appear in other locations such as the mucosal area. Persistent hyperpigmentation on the site of the lesion is normally seen after healing. Accompanying systemic symptoms are mild in FDE. The drugs mostly reported to cause FDE are: cotrimoxazole, tetracycline, metamizole, phenylbutazone, paracetamol, acetylsalicylic acid, NSAIDS, metronidazole, tinidazole, chlormezanone, amoxicillin, ampicillin, erythromycin, belladonna, griseofulvin, phenobarbitone, diflunisal, pyrantel pamoate, clindamycin, allopurinol, orphenadrine, albendazole, dapsone, phenolphthalein, oral contraceptives, phenacetin, doxycycline, minocycline, panmycin, sulfonamide, sulfasalazine, benzodiazepines and chlordiazepoxide, hyoscine butylbromide, and quinine [3,4].
A year-old woman received five doses of fluconazole ( mg) once a month for recurrent vaginal candidiasis. She was healthy but had a family history of atopic dermatitis. She noticed a red erythematous macule on the medial side of her right popliteal fossa after taking her second dose of fluconazole. With time, the macule faded, but a violet pigmentation developed. A month later, after taking another dose, she again developed two macules; one developed on exactly the same site and the other in the left popliteal fossa. Both patches were symmetrical and similar in appearance. Again, the patches faded and hyperpigmented areas developed. At this point, she was examined by a dermatologist and misdiagnosed with lichen planus and treated with topical clobetasol that led to the development of striae on both sites. Four hours after taking the fifth dose, the macules reappeared along with a new macule on her right upper lip. She suspected that the symptoms were caused by fluconazole and again visited a dermatologist. An oral challenge test with fluconazole ( mg) was conducted 4 weeks later and showed similar signs three hours after intake. Local provocation was performed with 10% fluconazole in petrolatum on the left pigmented area and 10% fluconazole in ethanol on the right pigmented area. For comparison, the same compounds were tested on normal skin on the back. After 16 hours, two red patches developed on both sides of her legs and none on her back. A skin biopsy specimen from the left popliteal area revealed a lichenoid infiltrate, a basal cell vacuolization, dermal melanophages and a superficial perivascular lymphocytic infiltrate consistent with FDE. Despite having a family history of atopic dermatitis, she had no major or minor symptoms of atopic dermatitis and she denied having any other reaction to drugs or any allergy history. We recommended that she discontinue using fluconazole.
To determine the cause of the recurrent vaginitis, her complete medical history was taken. She had experienced mid cycle spotting while using low-dose oral contraceptives therefore she switched to using high-dose oral contraceptives 2 years before our study. She was also working in a fitness center during that time and she mentioned that she wore a wet swimsuit for long periods of time and used tight synthetic clothes all of which were risk factors for vaginal candidiasis . At this time, we recommended that she use other contraceptive methods for example, condoms. Furthermore, we asked her to wear cotton underwear and informed her of preventive methods of candidiasis. We followed up with her after 6 months and she mentioned she had not experienced any other episode of candidiasis since then.
We discuss a rare case of fixed drug eruption due to fluconazole. We have found 16 other reports of FDE due to fluconazole although the site and appearance of the skin lesions were different among the reported cases. Thirteen out of 17 cases of FDE due to fluconazole, including ours, occurred in women [6,8]-[10,12]-. Most previous studies on FDE due to drugs demonstrated a higher occurrence in men compared to women according to research by Mahboob and colleagues . Contrarily, in their study, the ratio of women to men was . The number of reported cases of FDE due to fluconazole is too low to be discussed epidemiologically. However, the higher ratio of women could be due to the higher prescription of fluconazole to women due to vaginal candidiasis. The youngest patient reported was years-old  while the oldest one was years-old . The mean age ± SD of men who experienced FDE due to drugs in previous studies was ± 17 while it was ± 14 for women . In previous studies of FDE due to fluconazole, all female patients were prescribed fluconazole for vaginal candidiasis similar to our patient, while male patients were prescribed fluconazole for Candida balanitis , oral candidiasis , tinea corporis and tinea cruris . In almost all cases, eruption occurred after a couple of drug administrations. The only common medication used by patients was fluconazole. The most affected sites for eruptions were limbs, palmar and plantar areas [5,6,8,10,12] as well as the oral cavity and lips [6,8,9,11,14,15]. A report of vulvar FDE due to fluconazole has also been published recently . In our patient, both popliteal fossas and the upper lip were affected.
A study by Sharma and colleagues was conducted on patients who had FDE due to drugs. They reported that the trunk and limbs were the major sites with 24% followed by lips alone and genitalia with % and 20%, respectively. Another study compared cases of FDE and the results showed that 48% of lesions involved the lips followed by hands (%), arms (%), and legs () . They also reported that % of patients had multiple lesions compared to % who had a single eruption due to use of drugs . In a study conducted by Mahboob et al, % of patients with FDE had solitary lesions compared to the remaining patients who had more than one lesion . The same study also showed that 70% of patients with FDE experienced a bilateral involvement comparable to our study . To our knowledge, our study is the second documented case of successful patch testing for fluconazole . Alanko conducted a topical provocation test on 30 patients with FDE and concluded that the test is a useful and safe method. However, a positive test is more informative than a negative test in most drug reactions . One study demonstrated that an oral challenge test is a useful method as a tolerance test or to exclude drug hypersensitivity in cases of suspected drug reactions with negative skin tests . The skin test was positive in our patient. However, we did an oral test as well that was also positive. This was consistent with most of the reported cases [5,7,8,10,11,14]. It is important to note that diagnostic tests must be done carefully to prevent the rare occurrence of toxic epidermal necrolysis . Skin biopsies were performed in four cases [5,6,12,14] and the histopathology was consistent with FDE similar to our patient.
FDE: fixed drug eruption; PDM: Pa-demethylase; SJS: Stevens Johnson Syndrome.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
MT identified the adverse drug reaction, performed the literature review and wrote the first draft of the paper. NMR took the biopsy, undertook the histological analysis and finalized the manuscript. Both authors read and approved the final manuscript.
We are grateful to Linda Apps and Shirin Kiani who helped in editing this paper. We also wish to thank Kaveh Sayarirani for his expert help with the images.
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Articles from Journal of Medical Case Reports are provided here courtesy of BioMed Central
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Your dose will depend on the infection you are treating. Vaginal infections are often treated with only one pill. For other infections, your first dose may be a double dose. Carefully follow your doctor's instructions.
Fluconazole oral is taken by mouth. Fluconazole injection is given as an infusion into a vein.
You may take fluconazole oral with or without food.
Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).
Fluconazole injection is given as an infusion into a vein. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself. Prepare an injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.
Use fluconazole for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Fluconazole will not treat a viral infection such as the flu or a common cold.
Call your doctor if your symptoms do not improve, or if they get worse.
Store fluconazole at room temperature away from moisture and heat. Do not freeze.
You may store the oral suspension in a refrigerator, but do not allow it to freeze. Throw away any leftover liquid that is more than 2 weeks old.
Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.
pronounced as (floo kon' na zole)
Fluconazole is used to treat fungal infections, including yeast infections of the vagina, mouth, throat, esophagus (tube leading from the mouth to the stomach), abdomen (area between the chest and waist), lungs, blood, and other organs. Fluconazole is also used to treat meningitis (infection of the membranes covering the brain and spine) caused by fungus. Fluconazole is also used to prevent yeast infections in patients who are likely to become infected because they are being treated with chemotherapy or radiation therapy before a bone marrow transplant (replacement of unhealthy spongy tissue inside the bones with healthy tissue). Fluconazole is in a class of antifungals called triazoles. It works by slowing the growth of fungi that cause infection.
Fluconazole comes as a tablet and a suspension (liquid) to take by mouth. It is usually taken once a day, with or without food. You may need to take only one dose of fluconazole, or you may need to take fluconazole for several weeks or longer. The length of your treatment depends on your condition and on how well you respond to fluconazole. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take fluconazole exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor may tell you to take a double dose of fluconazole on the first day of your treatment. Follow these directions carefully.
Shake the liquid well before each use to mix the medication evenly.
You should begin to feel better during the first few days of treatment with fluconazole. If your symptoms do not improve or get worse, call your doctor.
Continue to take fluconazole until your doctor tells you that you should stop, even if you feel better. Do not stop taking fluconazole without talking to your doctor. If you stop taking fluconazole too soon, your infection may come back after a short time.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.
Fluconazole is also sometimes used to treat serious fungal infections that begin in the lungs and can spread through the body and fungal infections of the eye, skin and nails. Fluconazole is also sometimes used to prevent fungal infections in people who are likely to become infected because they have human immunodeficiency virus (HIV) or cancer or have had a transplant operation (surgery to remove an organ and replace it with a donor or artificial organ). Talk to your doctor about the possible risks of using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
Before taking fluconazole,
- tell your doctor and pharmacist if you are allergic to fluconazole, other antifungal medications such as itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), or voriconazole (Vfend), any other medications, or any of the ingredients in fluconazole tablets or suspension. Ask your pharmacist for a list of the ingredients.
- tell your doctor if you are taking astemizole (Hismanal) (not available in the US), cisapride (Propulsid) (not available in the US), erythromycin (E.E.S., E-Mycin, Erythrocin); pimozide (Orap), quinidine (Quinidex), or terfenadine (Seldane) (not available in the US). Your doctor will probably tell you not to take fluconazole if you are taking any of these medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking, or plan to take. Also you should tell your doctor you have taken fluconazole before starting to take any new medications within 7 days of receiving fluconazole. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with fluconazole, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor if you have or have ever had cancer; acquired immunodeficiency syndrome (AIDS); an irregular heartbeat; a low level of calcium, sodium, magnesium, or potassium in your blood; rare, inherited conditions where the body is not able to tolerate lactose or sucrose;or heart, kidney, or liver disease.
- tell your doctor if you are pregnant, especially if you are in the first 3 months of your pregnancy, plan to become pregnant, or are breastfeeding. Your doctor may tell you to use birth control to prevent pregnancy during your treatment and for 1 week after your final dose. If you become pregnant while taking fluconazole, call your doctor. Fluconazole may harm the fetus.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking fluconazole.
- you should know that fluconazole may make you dizzy or cause seizures. Do not drive a car or operate machinery until you know how this medication affects you.
Unless your doctor tells you otherwise, continue your normal diet.
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Dispose of any unused liquid medication after 14 days.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
In case of overdose, call the poison control helpline at Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at
Symptoms of overdose may include the following:
- hallucinations (seeing things or hearing voices that do not exist)
- extreme fear that others are trying to harm you
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to fluconazole.
Do not let anyone else use your medication. Ask your pharmacist if you have questions about refilling your prescription. If you still have symptoms of infection after you finish taking the fluconazole, call your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Browse Drugs and Medicines
Sores treat cold can fluconazole
Fluconazole for fungal infections Azocan, Diflucan, Canesten
|Type of medicine||An antifungal medicine|
|Used for||Fungal infections|
|Also called||Azocan®; Diflucan®; Canesten Oral®|
|Available as||Capsules, oral liquid medicine and injection|
Many types of fungi live harmlessly on our skin. However, some types of fungi can thrive and multiply on the surface of our bodies and cause infections of the skin, mouth or vagina. The most common fungi to cause skin infections are the tinea group of fungi. A common fungal infection of the mouth and vagina is called thrush. This is caused by an overgrowth of a yeast (which is a type of fungus) called candida.
Fungal infections sometimes occur within the body also. You are more at risk of developing an internal fungal infection if your immune system does not work properly. For example, if you are having chemotherapy, or if you are taking medicines for rheumatic disease, or if you have HIV/AIDS. Internal fungal infections can be serious.
You will have been prescribed fluconazole to treat a fungal infection, or to help prevent a fungal infection from developing. It works by killing yeast and fungi.
Fluconazole is available on prescription, and it can also be bought at pharmacies, without a prescription, for the treatment of vaginal thrush.
Before taking fluconazole
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking fluconazole it is important that your doctor or pharmacist knows:
- If you are pregnant or breastfeeding.
- If you have a heart rhythm problem.
- If you have problems with the way your liver works, or any problems with the way your kidneys work.
- If you have a rare inherited blood condition called porphyria.
- If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines. This is important because fluconazole can interfere with a number of other medicines and cause problems.
- If you have ever had an allergic reaction to a medicine.
How to take fluconazole
- Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about fluconazole and will provide you with a full list of the side-effects which you may experience from taking it.
- There are several strengths of fluconazole capsule available - 50 mg, mg, and mg. Your doctor or pharmacist will tell you what dose to take and how often to take it, as this will depend upon the nature of your infection/condition. The dose will be printed on the label of the pack to remind you of what was said. Fluconazole can be taken at any time of day, and can be taken either before or after a meal. Swallow the capsule with a drink of water.
- Infections such as vaginal thrush can be treated with a single mg dose; other infections require a course of treatment possibly lasting a number of weeks.
- If you have been prescribed a course of treatment, remember to continue taking the capsules/medicine until the course is finished. Fluconazole is usually prescribed as a once-daily dose. If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, skip the missed dose. Do not take two doses together to make up for a forgotten dose.
Getting the most from your treatment
- Remember to keep any regular appointments with your doctor. This is so your doctor can check on your progress. If you are taking a course of fluconazole, you may need to have a blood test to check that it is not affecting your liver if you are taking it for more than one month.
- If your symptoms do not improve despite taking fluconazole, speak again with your pharmacist or doctor so that your infection can be investigated further.
- If you buy any medicines, always check with a pharmacist that they are safe to take with fluconazole.
Can fluconazole cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with fluconazole. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Common fluconazole side-effects (these affect fewer than 1 in 10 people)||What can I do if I experience this?|
|Feeling sick (nausea) or being sick (vomiting), stomach ache, diarrhoea||Stick to simple foods and drink plenty of water|
|Headache||Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, let your doctor know|
|Skin rash||Let your doctor know about this|
|Changes to some blood test results||Your doctor will check for these if needed|
If you experience any other symptoms which you think may be due to fluconazole, discuss them with your doctor or pharmacist for further advice.
How to store fluconazole
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Treating Cold Sores With Valtrex and Other Prescription Drugs
Several medications, including Valtrex, are available to treat cold sores. Some are used topically (on the skin) and others are used orally (by mouth), but the goal is to treat cold sores as early as possible.
That's because starting a medication when prodromal symptoms such as burning, tingling, or redness begin will give a person with a cold sore the best chance of either preventing an actual blister from forming or shortening a blister's course once it does appear.
A Word on FDA Approval
A number of antiviral medications are used to treat herpes infections, which cause cold sores, also known as fever blisters.
While the FDA has approved the use of certain drugs for cold sores, some antiviral drugs aren't specifically FDA-approved for cold sores but have been shown in clinical studies to be effective treatments. Given this, receiving a prescription for an off-label use of one of these drugs may help eliminate or prevent cold sores.
The decision to use a medication that is prescribed off-label should be made based on current scientific data and discussed thoroughly with your healthcare provider.
Antiviral drugs can have several effects on oral herpes simplex viral infections, including cold sores. These medications can decrease the time that it takes for cold sores to heal and reduce symptoms, especially pain.
If taken soon enough, treatments can prevent lesions from occurring, reduce the number and size of lesions that develop, as well as decrease the amount of viral shedding (the point at which the virus is contagious).
The First Outbreak
The first outbreak of any herpes simplex infection is usually worse than recurrent infections. An initial outbreak of oral herpes should be treated with oral medications, while recurrences can be treated with topical or oral medications.
The first episode (which generally occurs in childhood) is also treated longer, usually for seven to 10 days with an antiviral medication. Recurrent infections, on the other hand, are treated for a shorter period of time.
Topical Denavir for Cold Sores
Denavir (Penciclovir 1 percent cream) is FDA-approved for recurrent cold sores. Starting treatment within one hour of an outbreak can reduce healing time by two days, as well as reduce symptoms. Denavir can also decrease the duration of viral shedding.
Overall, the earlier Denavir is started, the better the benefits. That being said, improvement is often still possible when treatment is started after vesicles (the cold sores) develop.
Zovirax (Acyclovir 5 percent cream) is also FDA-approved for the treatment of recurrent cold sores. In studies, frequent application of the cream reduced healing time by about 12 hours.
Oral acyclovir given five times a day for primary gingivostomatitis in children can substantially reduce the duration of fever, eating problems, and drinking difficulties, as well as viral shedding. Using low-dose oral acyclovir for cold sores can shorten the duration of symptoms, but higher doses may be needed to reduce pain.
Famvir (Famciclovir) is approved by the FDA for the treatment of cold sores. If started at the first sign of symptoms, taking a single high dose of Famvir can shorten the herpes infection by two days.
Valtrex (Valacyclovir) is also approved by the FDA to treat cold sores and it's a well-known, popular treatment. If started at the first sign of symptoms, taking Valtrex twice a day for one day can shorten the duration of a herpes infection.
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Chi CC, Wang SH, Delamere FM, Wojnarowska F, Peters MC, Kanjirath PP. Interventions for prevention of herpes simplex labialis (cold sores on the lips). Cochrane Database Syst Rev. ;(8):CD doi/CDpub2
Chen F, Xu H, Liu J, et al. Efficacy and safety of nucleoside antiviral drugs for treatment of recurrent herpes labialis: a systematic review and meta-analysis. J Oral Pathol Med. ;46(8) doi/jop
Harvard Health Organization. Cold Sores.
Klysik K, Pietraszek A, Karewicz A, Nowakowska M. Acyclovir in the Treatment of Herpes Viruses - a Review. Curr Med Chem. doi/
Vere hodge RA, Field HJ. Antiviral agents for herpes simplex virus.Adv Pharmacol. ; doi/B
Centers for Disease Control and Prevention. (). Sexually Transmitted Diseases Treatment Guidelines.
Usatine RP, Tinitigan R. Nongenital Herpes Simplex Virus. Am Fam Physician. Nov 1;82(9)
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Candida infections of the mouth, throat, and esophagus
Candidiasis is an infection caused by a yeast (a type of fungus) called Candida. Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems.1 Sometimes, Candida can multiply and cause an infection if the environment inside the mouth, throat, or esophagus changes in a way that encourages fungal growth.
Candidiasis in the mouth and throat is also called thrush or oropharyngeal candidiasis. Candidiasis in the esophagus (the tube that connects the throat to the stomach) is called esophageal candidiasis or Candida esophagitis. Esophageal candidiasis is one of the most common infections in people living with HIV/AIDS.2
Candidiasis in the mouth and throat can have many different symptoms, including:
- White patches on the inner cheeks, tongue, roof of the mouth, and throat (photo showing candidiasis in the mouth)
- Redness or soreness
- Cotton-like feeling in the mouth
- Loss of taste
- Pain while eating or swallowing
- Cracking and redness at the corners of the mouth
Symptoms of candidiasis in the esophagus usually include pain when swallowing and difficulty swallowing.
Contact your healthcare provider if you have symptoms that you think are related to candidiasis in the mouth, throat, or esophagus.
Risk and Prevention
Who gets candidiasis in the mouth or throat?
Candidiasis in the mouth, throat, or esophagus is uncommon in healthy adults. People who are at higher risk for getting candidiasis in the mouth and throat include babies, especially those younger than 1 month of age, and people with at least one of these factors:
- Wear dentures
- Have diabetes
- Have cancer
- Have HIV/AIDS
- Take antibiotics or corticosteroids, including inhaled corticosteroids for conditions like asthma
- Take medications that cause dry mouth or have medical conditions that cause dry mouth
Most people who get candidiasis in the esophagus have weakened immune systems, meaning that their bodies don’t fight infections well. This includes people living with HIV/AIDS and people who have blood cancers such as leukemia and lymphoma. People who get candidiasis in the esophagus often also have candidiasis in the mouth and throat.
How can I prevent candidiasis in the mouth or throat?
Ways to help prevent candidiasis in the mouth and throat include:
- Maintain good oral health
- Rinse your mouth or brush your teeth after using inhaled corticosteroids
Candida normally lives in the mouth, throat, and the rest of the digestive tract without causing any problems. Sometimes, Candida can multiply and cause an infection if the environment inside the mouth, throat, or esophagus changes in a way that encourages its growth.
This can happen when:
- a person’s immune system becomes weakened,
- if antibiotics affect the natural balance of microbes in the body,
- or for a variety of other reasons in other groups of people.
Diagnosis and Testing
Healthcare providers can usually diagnose candidiasis in the mouth or throat simply by looking inside.8 Sometimes a healthcare provider will take a small sample from the mouth or throat. The sample is sent to a laboratory for testing, usually to be examined under a microscope.
Healthcare providers usually diagnose candidiasis in the esophagus by doing an endoscopy. An endoscopy is a procedure to examine the digestive tract using a tube with a light and a camera. A healthcare provider might prescribe antifungal medicine without doing an endoscopy to see if the patient’s symptoms get better.
Candidiasis in the mouth, throat, or esophagus is usually treated with antifungal medicine.6 The treatment for mild to moderate infections in the mouth or throat is usually an antifungal medicine applied to the inside of the mouth for 7 to 14 days. These medications include clotrimazole, miconazole, or nystatin. For severe infections, the most common treatment is fluconazole (an antifungal medication) taken by mouth or through a vein. If patient does not get better after taking fluconazole, healthcare providers may prescribe a different antifungal. The treatment for candidiasis in the esophagus is usually fluconazole. Other types of prescription antifungal medicines can also be used for people who can’t take fluconazole or who don’t get better after taking fluconazole.
If you are a healthcare provider, click here to see the Infectious Diseases Society of America’s Clinical Practice Guidelines for the Management of CandidiasisExternalexternal icon.
The exact number of cases of candidiasis in the mouth, throat, and esophagus in the United States is difficult to determine. This is because there is no national surveillance for these infections. The risk of these infections varies based on the presence of certain underlying medical conditions. For example, candidiasis in the mouth, throat, or esophagus is uncommon in healthy adults. However, they are some of the most common infections in people living with HIV/AIDS.2 In one study, about one-third of patients with advanced HIV infection had candidiasis in the mouth and throat.9