• 약학회지
• /
• 제45권4호
• /
• pp.357-365
• /
• 2001

The purpose of this study is to investigate the influence of cyclodextrins (CDs) and different acids on the solubility of fluconazole, and o formulate its more concentrated parenteral aqueous solution. Solubility studies of fluconazole with 7-CD, 2-hydroxypropyl-$\beta$-CD (HPCD), sulfobutyl ether $\beta$-CD (SBCD) and dimethyl-$\beta$-CD(DMCD) were performed. The aqueous solubility of fluconazole was measured in different concentrations of different acids with or without addition of CDs. Solubility of fluconazole increased in the rank order of $\beta$-CD$^1$H-NMR studies confirmed the formation of an inclusion complex of fluconazole with HPCD. It was also shown by the NMR studies that the complex formed was a 1:1 complex. Among the different acids used, maleic acid and phosphoric acid increased solubility of fluconazole. The lower the pH of solution is, the more fluconazole dissolved, regardless of acids. Addition of HPCD (50 mM) to acid solutions increased the solubility about two times. New fluconazole injections at a dose of 10 mg/ml could be prepared in aqueous solutions containing 10% HPCD or 15% SBCD. These parenteral solutions did not form any precipitates at 4$^{\circ}C$ and was very stable at elevated temperatures. These results demonstrate that it is possible to develop a parenteral aqueous solution of fluconazole with a smaller injection volume using HPCD or SBCD.

• 한국임상약학회지
• /
• 제32권3호
• /
• pp.204-214
• /
• 2022

Objective: This study aimed to investigate the occurrence and types of the adverse events (AEs) associated with oral fluconazole and itraconazole and factors associated with specific types of AEs. Methods: We analyzed AEs reported by community pharmacies nationwide over 10 years using the Korea Adverse Event Reporting System database. Various AE terms were categorized into 18 types, and concomitant medications were classified by drug-drug interaction (DDI) severity. The relationship between the specific type of AE and age, sex, and number of concomitant medications was investigated using multiple logistic regression analysis. Results: A total of 879 AE reports of fluconazole and 401 reports of itraconazole were analyzed; of these reports, 321 and 83 reports of fluconazole and itraconazole, respectively, described concomitant drug administration categorized as DDI severity of contraindicated or major. Women had a higher risk of psychiatric AEs associated with fluconazole use (OR, 1.587; p=0.042). Polypharmacy increased the risk for psychiatric AEs (OR, 3.598; p<0.001 for fluconazole and OR, 2.308; p=0.046 for itraconazole). In dermatologic AEs, the mean age of patients who received itraconazole was lower than that of patients who received fluconazole (46.3±16.8 vs. 54.9±15.4; p<0.001). Co-administration of fluconazole with 1-3 drugs increased the risk of neurological AEs (OR, 1.764; p=0.028). Conclusion: When using fluconazole and itraconazole, psychiatric AEs should be noted, particularly in women and in case of polypharmacy; moreover, when fluconazole is co-administered with other drugs, attention should be paid to the occurrence of neurological AEs.

• Clinical and Experimental Pediatrics
• /
• 제64권4호
• /
• pp.172-179
• /
• 2021

Background: Evidence shows that fluconazole prophylaxis is an effective treatment against invasive fungal infections in preterm neonates, however, the most efficient schedule of fluconazole prophylaxis for the colonization and mortality of invasive candidiasis (IC) is unknown. Purpose: This systematic review and meta-analysis aimed to assess the efficiency of different prophylactic fluconazole schedules in controlling IC colonization, infection, and mortality in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in neonatal intensive care units. Methods: We searched the PubMed, Scopus, Embase, and Cochrane databases using the keywords "candida," "invasive candidiasis," "IC," "fluconazole prophylaxis," "preterm infants," "very low birth weight infants," "VLBW," "extremely low birth weight," and "ELBW." Results: Mortality was significantly decreased in a meta-analysis of studies using different fluconazole prophylaxis regimens. The meta-analysis also indicated a significant decrease in the incidence of IC-associated mortality in ELBW infants using the same fluconazole prophylaxis schedules. Conclusion: Future studies should explore the effectiveness of other different fluconazole prophylaxis schedules on IC colonization, infection, and mortality.

• Clinical and Experimental Pediatrics
• /
• 제50권7호
• /
• pp.636-642
• /
• 2007

목 적 : 면역력이 약한 미숙아나 저체중 출생아에 여러 가지 침습적 조작으로 인한 항생제 사용이 진균 감염, 특히 칸디다 감염의 위험을 증가시킨다. 이를 감소시키기 위한 방법으로 fluconazole 예방요법이 칸디다 감염율과 사망률을 감소시켰다는 보고가 있다. 본 연구는 1,500 g 미만의 극소저체중 출생아들에 대한 예방적 항진균제 사용이 칸디다 감염의 발생을 감소시키는데 효과적인지 알아보고자 하였다. 방 법 : 전남대학병원 신생아중환자실에 입원한 1,500 g 미만의 극소저체중 출생아 중 기관내 삽관이나 제대 동정맥 또는 경피적 중심정맥 삽입술을 받은 환아로, 예방적으로 항진균제를 사용하지 않았던 2005년 1월 1일부터 2005년 7월 31일까지 7개월간의 환아를 'fluconazole 비사용군'으로, 사용하였던 2006년 1월 1일부터 2006년 7월 31일까지 7개월간의 환아를 'fluconazole 사용군'으로 하였다. 사용군 29명, 비사용군 28명을 대상으로 진균 감염의 위험인자로 알려진 임상특성과 칸디다 감염증의 발생빈도, 사망률 및 fluconazole의 약물 부작용을 관찰하였다. Fluconazole은 생후 첫 3일에 시작하여 4주간 예방적으로 투여하였으며 시행 첫 1주일은 체중(kg)당 3 mg을 3일 간격으로, 그 다음 주부터는 격일로 투여하였다. 결 과 : 두 군 사이에 재태주령, 출생체중, 성별, 쌍생아, 분만방식에 차이는 없었다. 산과적 인자인 장기 조기 양막파수, 융모양막염 및 산전 스테로이드 사용 빈도에 유의한 차이는 없었다. 신생아 칸디다 감염증의 위험인자로 알려진 1,000 g 미만 초극소저체중 출생아 빈도와 예방적 항생제 사용, 총정맥내 영양요법, 제대동정맥 삽입술 빈도와 유지기간, 지방유제 투여기간 및 기관내 삽관과 지속적 양압환기 사용기간에 두 군간 차이는 없었으나, 비사용군에 비해 사용군이 경피적 중심정맥 삽입술과 지방유제 사용빈도가 높았고 경피적 중심정맥관 유지기간이 길었다. Fluconazole 사용군과 비사용군 간에 진균감염의 빈도와 사망률에 유의한 차이는 없었다. 사용군에서 Malassezia 진균혈증이 5명 발생하였지만 칸디다 감염은 1명도 발생하지 않아 비사용군 5명(칸디다혈증 3명, 침습성 칸디다증 2명)에 비해 유의하게 감소하였다(P<0.05). 결 론 : 극소저체중 출생아에서 fluconazole의 예방적 투여가 칸디다 감염의 발생빈도를 유의하게 감소시키는 것으로 보아 비용-효과 면에서 항진균제의 예방적 투여가 고려될 수 있겠으나, Malassezia 진균혈증의 증가 원인에 대해서도 추가적인 연구가 필요할 것으로 사료된다.

• Archives of Pharmacal Research
• /
• 제20권2호
• /
• pp.171-175
• /
• 1997

The stability of ondansetron and fluconazole in 5% dextrose injection and normal saline during simulated Y-site injection at room temperature was studied. Ondansetron 0.03, 0.1 and 0.3 mg/ml were admixed 1:1 with fluconazole 2 mg/ml. The solutions were stored at room temperature and samples were retrieved at time 0, 1, 2, 4 and 12 hr for immediate assay. At the time of the assay and before any dilution, each sample was visually inspected for clarity, color, precipitation, and the pH was determined. Drug concentrations were measured by a stability-indicating high performance liquid chromatograph. Ondansetron 0.03, 0.1 and 0.3 mg/ml were stable when mixed with concentration of fluconazole 2 mg/ml. There were no change in clarity and color and no precipitates in any admixture for 12 hr of inspection. The pH measurements did not have a particular trend in any direction over time.

• Bulletin of the Korean Chemical Society
• /
• 제14권2호
• /
• pp.262-265
• /
• 1993

Conformational free energy calculations using an empirical potential function and a hydration shell model (program CONBIO) were carried out on antifungal agent fluconazole in the unhydrated and hydrated states. The initial geometry of fluconazole was obtained from two minimized fragments of it using a molecular mechanics MMPMI and followed by minimizing with a semiempirical AM1 method. In both states, the feasible conformations were obtained from the calculations of conformational energy, conformational entropy, and hydration free energy by varying all the torsion angles of the molecule. The intramolecular hydrogen bonds of isopropyl hydroxyl hydrogen and triazole nitrogens and the structural flexibility are of significant importance in stabilizing the conformations of fluconazole in both states. Hydration is proved to be one of the essential factors in stabilizing the overall conformation in aqueous solution. Two F atoms of phenyl ring are not identified as an essential key in determining the stable conformations and may be responsible for the interaction with the receptor of fluconazole.

• Journal of Pharmaceutical Investigation
• /
• 제30권1호
• /
• pp.51-54
• /
• 2000

A column-switching high performance liquid chromatographic method has been developed for the determination of a fluconazole in human plasma. Each plasma sample was centrifuged for 10 min at 5000 g. After an aliqout of the supernatant was taken to nylon microcentrifuge filter, these samples were centrifuged for 10 min at 5000 g. An aliqout of the supernatant was injected directly onto the HPLC column. Deionized water was run for 2 min at a flow rate of 1.0 ml/min to retain fluconazole in an extration column, while proteins and endogenous interferences were eluted to the waste. The analyte was then back-flushed onto an analytical column, $C_{18}$ reversed-phase column. The mobile phase for analytical column, 0.01 M sodium acetate (pH 5.0)-methanol (65:35, v/v), was run at a flow rate of 1.0 ml/min. The column effluent was monitored by ultraviolet detection at 261 nm. The retention time for fluconazole was 11.76 min in human plasma. The detection limit for fluconazole in human plasma was $0.2\;{\mu}g/ml$. No interference from endogenous substances was observed.

• Journal of Pharmaceutical Investigation
• /
• 제39권3호
• /
• pp.207-216
• /
• 2009

Fluconazole is used as an orally administrated antifungal drug for the treatment of tinea corporis, candidiasis including skin mycotic pneumonia infections. The dosage of fluconazole varies with indication ranging from 50 mg/day to 400 mg/day. The fluconazole capsule 50 mg (3 capsules daily) is already available in Korean market. To improve the patient compliance, a fluconazole tablet 150 mg (once a day administration) was developed recently. The purpose of this study was to evaluate the bioequivalence of three doses of fluconazole capsule 50 mg (Diflucan 50 mg, Pfizer Korea Inc., as a reference drug) and a single dose of fluconazole tablet 150 mg (Plunazol 150 mg, Daewoong Pharm. Co., Korea) according to the guidelines of the Korea Food and Drug Administration (KFDA). The bioequivalence for three capsules of Diflucan 50 mg and a single tablet of Plunazol 150 mg was investigated in twenty-four healthy male volunteers under a randomized 2${\times}$2 crossover trial design. The average age of twenty-four volunteers was 24.78${\pm}$3.27 year-old, average height was 175.56${\pm}$5.45 cm and average weight was 67.24${\pm}$6.86 kg. After three capsules of Diflucan 50 mg or a single tablet of Plunazol 150 mg were orally administered, blood was taken at predetermined time intervals and the plasma concentrations of fluconazole in plasma were determined using LC-MS-MS. The 90% confidence intervals for the main parameters of statistical results after logarithmic transformation were AUCt 0.9272-1.0084 and Cmax 0.8423-0.9544 respectively, which are in the range of log 0.8 to log 1.25 and the statistical results of additional parameters (AUClast, t1/2 and MRT) were also in the 90% confidence interval that is in the range of log 0.8 to log 1.25. Therefore, the results of this study confirm the bioequivalence of three capsules of Diflucan 50 mg to one tablet of Plunazol 150 mg.

• Journal of Pharmaceutical Investigation
• /
• 제33권2호
• /
• pp.135-140
• /
• 2003

Fluconazole is an orally active bis-triazole antifungal agent, which is used in the treatment of superficial and systemic candidiasis and in the treatment of cryptococcal infections in patients with the acquired immuno deficiency syndrome (AIDS). The purpose of the present study was to evaluate the bioequivalence of two fluconazole capsules, Diflucan (Pfizer Pharmaceuticals Korea Inc.) and Flucona (Korean Drug Pharmaceuticals Co., Ltd.), according to the guidelines of Korea Food and Drug Administration (KFDA). The fluconazole release from the two fluconazole capsules in vitro was tested using KP VII Apparatus II method at 0.1 M hydrochloride dissolution media. Twenty normal male volunteers, $23.60{\pm}1.88$ years in age and $63.57{\pm}6.17\;kg$ in body weight, were divided into two groups and a randomized $2{\times}2$ cross-over study was employed. After three capsules containing 50 mg as fluconazole was orally administered, blood was taken at predetermined time intervals and the concentrations of fluconazole in serum were determined using HPLC method with UV detector. The dissolution profiles of two fluconazole capsules were very similar at 0.1 M hydrochloride dissolution media. Besides, the pharmacokinetic parameters such as $AUC_t,\;C_{max}\;and\;T_{max}$ were calculated and ANOVA test was utilized for the statistical analysis of the parameters using logarithmically transformed $AUC_t$ and $C_{max}$ and untransformed $T_{max}$. The results showed that the differences in $AUC_t,\;C_{max}\;and\;T_{max}$ between two capsules based on the Diflucan were 4.96%, 5.65% and -13.76%, respectively. There were no sequence effects between two capsules in these parameter. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log(0.8) to log(1.25) $(e.g.,\;log(1.01){\sim}log(1.08)\;and\;log(1.00){\sim}log(1.12)\;for\;AUC_t\;and\;C_{max},\;respectively)$, indicating that Flucona capsule is bioequivalent to Diflucan capsule.

• Mycobiology
• /
• 제31권2호
• /
• pp.95-98
• /
• 2003

Aantifungal agents were tested against 30 clinical isolates of Cryptococcus neoformans var. neoformans using the NCCLS method(M27-A2). Posaconazole, itraconazole and amphotericin B had lower MIC than the remaining four antifungal agents. The MIC result for posaconazole was over 220-fold lower active than fluconazole. Fluconazole MICs for most isolates fell within the dose-dependant range. The overall MIC ranges and $MIC_{50}s$ were amphotericin B(0.03-0.25; 0.25), fluconazole(0.5-64; 16), itraconazole(0.015-1; 0.125), terbinafine(0.06->2; 1), caspofungin(8-32; 32), voriconazole(0.015-0.5; 0.25), and posaconazole(0.015-0.25; 0.06 ${\mu}g/ml$), respectively. In conclusion, the $MIC_{50}s$ of these drugs did not exhibit any sign of an upward shift with the exception of fluconazole and tendency cross-resistance between the seven drugs was not observed. We conclude that in vitro resistance to antifungal agents has not significantly changed despite the recent wide-spread use of triazoles for long-term treatment of Cryptococcal meningitis.