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Review

Fluconazole

No authors listed
In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
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Review

Fluconazole

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Excerpt

Fluconazole is a triazole fungistatic agent used in the treatment of systemic and superficial fungal infections. Fluconazole therapy can cause transient mild-to-moderate serum aminotransferase elevations and is a known cause of clinically apparent acute drug induced liver injury.

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References

    1. Zimmerman HJ. Antifungal agents. Hormonal derivatives and related drugs. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 609-11.(Expert review of hepatotoxicity of antifungal agents published in 1999 mentions that fluconazole has been implicated in cases of hepatic injury with jaundice).
    1. Moseley RH. Antifungal agents. Antibacterial and antifungal agents. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 470-81. (Review of hepatotoxicity of antifungal agents; mentions that asymptomatic elevations in liver enzymes occur in less than 7% of patients treated with fluconazole, but the rate may be higher in patients with HIV infection, and that at least 3 deaths from acute hepatocellular injury have been described).
    1. Bennett JE. Antimicrobial agents: antifungal agents. In, Brunton LL, Chabner BA, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill, 2011, pp. 1571-92.(Textbook of pharmacology and therapeutics; a fluorinated bistriazole, fluconazole is used for candidiasis and cryptococcosis; it is an inhibitor of CYP 3A4 and CYP 2C9 and may increase plasma levels of several drugs).
    1. Stern JJ, Hartman BJ, Sharkey P, Rowland V, Squires KE, Murray HW, Graybill JR. Oral fluconazole therapy for patients with acquired immunodeficiency syndrome and cryptococcosis: experience with 22 patients. Am J Med 1988; 85: 477-80. (Open label study of fluconazole for 8-64 weeks in 22 patients with AIDS and cryptococcal infection; serum aminotransferase levels became abnormal in four patients [19%]). - PubMed
    1. De Wit S, Weerts D, Goossens H, Clumeck N. Comparison of fluconazole and ketoconazole for oropharyngeal candidiasis. Lancet 1989; 1: 746-50. (Randomized trial of fluconazole vs ketoconazole in 37 patients with HIV infection and oropharyngeal candidiasis; ALT or AST elevations occurred in 1 of 18 [6%] on fluconazole vs 4 of 19 [21%] on ketoconazole; fluconazole was also more effective). - PubMed

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