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An effective and convenient treatment for thrush.
Canesten Capsule is an effective single dose treatment for vaginal thrush. It can also be used to treat your partner if he is suffering from thrush on the penis.
Adults age 16 to 60 years: Swallow the capsule whole with a glass of water (with or without food).
Do not use if you are pregnant, trying for a baby or breast feeding. Do not use if you are taking terfenadine of cisapride. Consult your doctor or a pharmacist before use if you are taking any medication other than the contraceptive pill and if you are aged under 16 or over 60.
Symptoms should disappear within two days of treatment. If symptoms persist for more than 7 days, see your doctor.
Not suitable for oral thrush.
Product information leaflet:
http://emc.medicines.org.uk/medicine/13959/SPC/Canesten Oral Capsule/
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Fluconazole 150mg
Hard capsule
Opaque light blue capsule (size 1) printed “Canesten”
Canesten Oral Capsule is recommended for the treatment of candidal vaginitis, acute or recurrent. It should also be used for the treatment of partners with associated candidal balanitis.
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Adults (16 to 60):
One capsule should be swallowed whole.
Children (under 16):
Paediatric use is not recommended.
Elderly:
Not recommended in patients over 60.
Renal Impairment:
There is no separate dosage schedule in patients with renal impairment for single dose therapy.
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Known hypersensitivity to fluconazole, related azole compounds or any of the excipients in this product.
Fluconazole should not be administered concomitantly with terfenadine or cisapride
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The drug interactions listed below relate to the use of multiple dose fluconazole. The relevance of this to a single dose of fluconazole 150mg has not been established.
Anticoagulants:
Fluconazole increased the prothrombin time after warfarin administration in healthy males during an interaction study. The change was small (12%) but bleeding events such as bruising, epistaxis, gastrointestinal bleeding, hematuria and melena have been reported in association with increases in prothrombin time in patients receiving fluconazole and warfarin concomitantly. Careful monitoring of prothrombin time in patients receiving coumarin type anticoagulants is recommended.
Sulphonylureas:
In healthy volunteers, fluconazole prolonged the serum half-life of oral sulphonylureas such as chlorpropamide, glibenclamide, glipizide and tolbutamide, when co-administered. Fluconazole and oral sulphonylureas may be concomitantly administered to diabetics but the possibility of an hypoglycaemic episode should be considered.
Hydrochlorothiazide:
Co-administration of fluconazole and multiple dose hydrochlorothiazide to healthy volunteers during a kinetic interaction study, increased plasma concentrations of fluconazole by 40%. However, although the prescriber should bear this in mind, the fluconazole dose in patients receiving concomitant diuretics should not need to be altered.
Benzodiazepines:
Substantial increases in midazolam concentrations and psychomotor effects are observed when oral midazolam and fluconazole (oral or intravenous) are co-administered. The effect on midazolam appears to be greater when fluconazole is administered orally than when fluconazole is administered intravenously. If concomitant administration of benzodiazepines and fluconazole is required then the prescriber should consider reducing the benzodiazepine dose and appropriate monitoring of the patient should be undertaken.
Phenytoin:
Levels of phenytoin may increase to a clinically significant degree during co-administration with fluconazole. Phenytoin levels should be monitored and the phenytoin dose adjusted to maintain therapeutic levels if co-administration is necessary.
Oral Contraceptives:
Studies on the use of combined oral contraceptives with multiple doses of fluconazole have been performed. No relevant effects on hormone levels occurred during a study with fluconazole 50mg, whilst the AUCs of ethinylestradiol and levonorgestrel were increased by 40% and 24% respectively during a study with fluconazole 200mg. It is therefore considered that multiple dose fluconazole is unlikely to affect the efficacy of the combined oral contraceptive.
Rifampicin:
A 25% decrease in the AUC and 20% shorter half-life of fluconazole occurred when fluconazole and rifampicin were administered concomitantly. An increase in the fluconazole dose should be considered in patients receiving concomitant rifampicin.
Endogenous Steroid:
No effect on endogenous steroid levels was observed in females when treated with fluconazole 50mg daily. No significant effect on endogenous steroid levels or on ACTH stimulated response was observed in healthy male volunteers when treated with fluconazole 200 to 400mg daily.
Ciclosporin:
In a kinetic study it was found that fluconazole 200mg daily slowly increases ciclosporin concentrations in renal transplant patients, but a multiple dose study with fluconazole 100mg daily showed no effect on ciclosporin levels in patients with bone marrow transplants. It is therefore recommended that ciclosporin plasma concentration is monitored in patients receiving fluconazole.
Theophylline:
Use of fluconazole 200mg for 14 days showed an 18% decrease in the mean plasma clearance of theophylline. Patients who require high doses of theophylline or who may be at increased risk of theophylline toxicity should be monitored for signs of theophylline toxicity when fluconazole is co-administered. The therapy should be modified if signs of toxicity occur.
Terfenadine:
Fluconazole 200mg daily did not show a prolongation in the QTc interval. Use of fluconazole (taken in multiple doses of 400mg and 800mg per day) and terfenadine concomitantly, significantly increased plasma levels of terfenadine. Spontaneous reports of palpitations, tachycardia, dizziness and chest pains have occurred in patients taking fluconazole and terfenadine concomitantly where the relationship of the reported adverse events to drug therapy or underlying medical condition is uncertain. It is recommended that terfenadine and fluconazole should not be administered concomitantly due to the potential seriousness of such an interaction. (See 4.3).
Cisapride:
Cardiac events including torsades de pointes have been reported in patients receiving fluconazole and cisapride concomitantly. Most of these patients appear to have been predisposed to arrhythmias or had serious underlying medical conditions, and the relationship of the reported events to a possible drug interaction is uncertain. Co-administration of cisapride is contra-indicated in patients receiving fluconazole. (See 4.3).
Zidovudine:
Zidovudine levels in AIDS or ARC patients were determined before and after daily treatment with fluconazole 200mg for 15 days. A significant increase in zidovudine AUC was observed (20%). A second study in HIV infected patients also showed a significant increase in zidovudine AUC (74%) when fluconazole was administered concomitantly. Patients received zidovudine 200mg every eight hours either with or without fluconazole 400mg for seven days on two occasions, 21 days apart. The increased zidovudine levels are most likely caused by a decrease in the conversion of zidovudine to its major metabolite. It is recommended that patients receiving fluconazole and zidovudine be monitored for zidovudine related adverse reactions.
Rifabutin:
Increased serum levels of rifabutin have been reported in patients receiving fluconazole and rifabutin concomitantly, suggesting a possible interaction. Uveitis has also been reported in patients receiving this combination. It is therefore recommended that patients are carefully monitored.
Tacrolimus:
Increased serum levels of tacrolimus have been reported in patients receiving fluconazole and tacrolimus concomitantly, suggesting a possible interaction. There have also been reports of nephrotoxicity in patients receiving this combination. It is recommended that patients receiving this combination are carefully monitored.
Astemizole or other drugs metabolised by the cytochrome P450 system taken concomitantly with fluconazole may be associated with elevations in serum levels of these drugs in patients. Fluconazole should be co-administered with caution in these circumstances and careful monitoring of patients should be undertaken.
Studies show that when fluconazole is taken orally with food, cimetidine, antacids or following total body irradiation for bone marrow transplantation, the absorption of fluconazole is not significantly impaired.
Drug – drug interaction studies with other medications have not been conducted but prescribers should be aware that such interactions may occur.
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