Frågedatum: 2004-04-30
RELIS database 2004; id.nr. 20322, DRUGLINE
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Is jaundice a known adverse effect of fluconazole (Diflucan) treatment?/nAn 88-year-old woman is di



Fråga: Is jaundice a known adverse effect of fluconazole (Diflucan) treatment?

An 88-year-old woman is diagnosed with a fungal infection and is treated with fluconazole (Diflucan) for a month. The last day of treatment she is becoming icteric.

Sammanfattning: Transient elevation of transaminases is well known for fluconazole. Jaundice, however, has only been reported in a few cases, mainly in patients with severe underlying diseases.

Svar: A thorough literature search has been done in available pharmacological literature and medical databases. Liver enzyme elevations have been reported for fluconazole in many studies. These are mostly mild and transient and disappear upon discontinuation of the drug (1,2,3). In addition, cholestasis, clinical hepatitis, fulminant liver failure and even death have been reported after fluconazole treatment (3). The severe liver injuries have, in most cases, affected immunocompromised patients. Two case reports of fluconazole-induced icterus have been found in the literature (4,5).

The first case involves an HIV-positive man with a pre-existing liver damage. He became jaundiced on his fourth short-term treatment with fluconazole the same year. When fluconazole was withdrawn his bilirubin- and ASAT-levels fell. Despite the fact that this patient had a pre-existing liver damage, the authors suggested that fluconazole was the cause of the jaundice due to the improvement after withdrawal. They recommend that fluconazole should be used with care in long-term treatment and in patients with a pre-existing liver disease (4). The second case report concerns an HIV-positive man becoming icteric after ketoconazole treatment. Since his candida infection did not improve, treatment with fluconazole was started and his liver function worsened. Upon discontinuation of fluconazole, his liver function improved (5).

In the files of SADRAC (the Swedish Drug Reactions Advisory Committee) there are three reports of fluconazole-induced icterus (6). One of the patients was an HIV-positive man who later died in severe liver and renal insufficiency. The two other patients improved after withdrawal of fluconazole.

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