Fluconazole during pregnancy: can it be used in the early stages, during the 2nd and 3rd trimesters

While carrying a child, a woman becomes vulnerable to many infections that her immune system normally can easily cope with. The body's defenses are reduced so that the woman's immune system does not reject the fetus, which is perceived as an element foreign to the body. One of the most common problems during pregnancy is thrush, or vulvovaginal candidiasis. The question of whether Fluconazole can be taken during pregnancy to treat thrush or any other mycosis is decided by the doctor individually for each patient.

What is Fluconazole

This drug was created to combat pathogenic fungi. Fluconazole is sold in capsules and tablets with varying concentrations of the active ingredient, in the form of vaginal suppositories. The action of the drug, according to the instructions, is based on the destruction of the membranes of pathogenic fungi.
It is used to combat cryptococcosis, candidiasis and other fungal infections. The medicine is used to prevent thrush, when the immune defense is reduced. Tablets should be used with caution and only after consultation with a gynecologist.

Description of the drug

Fluconazole is recognized as a highly effective antifungal medication, widely used for the treatment of diseases caused by reproducing fungi, such as vaginal candidiasis or, in other words, thrush. The medicine is produced in the form of tablets or capsules, which, as a rule, have different dosages of the main active substance, fluconazole.

The main substance of the drug, when it enters the human body, reduces the activity of pathogenic harmful microorganisms, disrupts the integrity of membranes and stops their further increase and reproduction. Fluconazole is prescribed for therapy:

cryptococcosis;
candidiasis of the mucous membranes, including the female genital organs;
infection caused by fungi and resulting from reduced immunity.

The dosage of the drug is selected by the attending physician, based on the results of laboratory tests and the complexity and characteristics of the patient’s disease.

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pharmachologic effect

The drug inhibits the synthesis of fungal sterols, affects fungal enzymes, preventing their reproduction. By making the pathogenic cell membrane more permeable, it slows down its growth and division. Fluconazole, being a triazole compound, is considered one of the most effective antifungal drugs against pathogens such as Candida spp., including visceral candidiasis, Cryptococcus neoformans, including intracranial infections, Trichophytum spp., Microsporum spp. The ability of Fluconazole to resist pathogens of endemic mycoses has been proven.

Diagnosis of candidiasis in pregnant women

Diagnosis of candidiasis: examination
Inspection. A gynecologist, as a rule, diagnoses candidiasis already at the examination stage, however, to exclude a mixed infection, cultures will still be prescribed. Bacvaginosis, some sexually transmitted infections, and helminthiasis may look similar;
Vaginal smear. A tampon is inserted into the vagina, from the contents of which a smear is subsequently prepared. The smear can reveal the fungus itself and signs of inflammation.

Indications for use

Fluconazole is prescribed if patients have:

cryptococcosis, including cryptococcal meningitis, as well as pulmonary or skin infections of this type;
candidiasis of the mucous membranes;
candidiasis of other organs;
cutaneous mycosis;
pityriasis versicolor;
onychomycosis and skin candidal infections;
endemic mycoses;
fungal infections caused by weakened immunity.

Fluconazole during pregnancy

Thrush often occurs in pregnant women because the immune system is weakened. Factors that alleviate the onset of the disease are synthetic underwear, antibiotics and hormones. Thrush causes redness and itching in the genital area, accompanied by a white discharge. To treat fungal infections of the body, agents are used that do not allow the fungus to multiply. All these drugs are prohibited from being used during pregnancy and breastfeeding to avoid unwanted consequences. Only a doctor should prescribe antifungal therapy to patients.

Clinical manifestations of candidiasis - when a pregnant woman can be prescribed fluconazole

Vaginal candidiasis in pregnant women often develops asymptomatically. An exacerbation occurs, as a rule, with the onset of a concomitant disease, for example, ARVI, or with a homonal change (which is generally impossible to predict).

Itching appears, the amount of discharge (leucorrhoea) increases, and pain may occur during urination and/or sexual intercourse. The vaginal mucosa turns red and an unpleasant odor appears. By the way, a bacterial infection likes to accompany vaginal candidiasis. Only a doctor can determine exactly what attacks the mucous membranes. It is the mixed infection that causes diseases of the ureters, bladder, and kidneys.

To treat a mixed infection, the doctor, in addition to fluconazole, may also prescribe an antibiotic (ofloxacin, ciprofloxacin, etc.), which, by the way, is also not indicated for pregnant women, since without kidneys it will still not be possible to carry the fetus to term.

Can I take Fluconazole during pregnancy?

The danger of using Fluconazole during pregnancy is that it can penetrate through the placental barrier. If you take a pill, the drug can affect the formation of the fetus. Similarly, during lactation, it enters the body of infants through mother's milk, where there may be a high concentration of Fluconazole.

When it enters the child’s blood, the drug interferes with developmental processes. There are many reviews of mothers who drank the medicine in the first weeks of pregnancy or during breastfeeding without any unpleasant consequences, but only specialists can be trusted in these matters. In the meantime, the latter assure that Fluconazole and pregnancy are incompatible.

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Fluconazole is contraindicated especially in the first trimester. The consequence can be not only miscarriage or death of the child, but also mutations and disturbances in the development of the fetus. Penetration of the drug into the blood of the fetus affects the formation of its skeleton, internal organs and muscles. This makes its use unacceptable in the second trimester, since it increases the risk of developmental anomalies. If treatment is necessary, the specialist will select from the list of medications those that do not cause such harm.

In some cases, a woman carrying a child is recommended to take Fluconazole for the following reasons:

insufficient effectiveness of other drugs in the development of the disease;
danger to the life of a woman and child;
the likelihood that the disease can cause miscarriage or premature birth.

The decision to take pills is made only by a specialist after a thorough examination. There is an opinion that there may be no side effects with careful monitoring of oral doses of no more than 400 mg. It is stated that with a carefully selected course of Fluconazole, the chance of abnormalities occurring in the fetus is significantly reduced. The doctor assesses the risks and makes an informed decision, taking into account the characteristics of the mother’s body and the development of the fetus.

In the early stages

It is strictly forbidden for pregnant women to take fluconazole at an early stage. Research by Danish scientists shows that using the drug in the first trimester is fraught with the appearance of defects in the fetus that require termination of pregnancy. Experts from the USA confirm the ability of the drug to cause mutations when taken in the first trimester. In this case, the antifungal drug leads, in addition to abnormalities, to arrest of fetal development or miscarriage.

In the 2nd trimester

This is the most crucial period for the expectant mother, since during this period of pregnancy there is an increase in the rate of development of the fetal muscle structure. Internal organs are actively developing. Taking Fluconazole in the second trimester is strictly unacceptable , since the medicine affects these processes, disrupting the natural formation of the muscle corset and leading to various abnormalities. The consequences will be dire.

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In the 3rd trimester

This period, when the final phase of fetal formation occurs, is especially important for the formation of the child’s brain. A fungal disease of the mother at this stage can have the most detrimental effect on the development of the fetus. If thrush or other severe infections occur and experts conclude that they can cause harm to the fetus, the patient may be prescribed drug therapy.

Consequences of generalized (severe) forms of candidiasis in pregnant women

Let's start with the fact that pregnancy as a condition predisposes to candidiasis. Due to sharp fluctuations in estrogen, the vaginal pH can shift significantly to the neutral side. Due to the disappearance of the acidic environment, pathogenic microorganisms colonize there, and most often, candida, which manifests itself in the form of thrush (vaginal candidiasis).

The fungus causes inflammation, suppresses the immune system, and can contribute to ascending urinary tract infections, which can lead to kidney disease. After childbirth, the fungus may disappear, or it may become a chronic process. Quite often you can find a figure of 5% regarding the frequency of chronic candidiasis among all forms of the disease. Any gynecologist will point out that this figure is underestimated by at least 6 times - candidiasis tends to become chronic, and every third woman has relapses of thrush several times a year.

So, here are the main consequences of candidiasis in pregnant women:

Cases of spontaneous miscarriage have been repeatedly recorded. These are not isolated cases, compared to a 20-fold therapeutic dose of fluconazole (animal experience), in humans, miscarriages due to generalized mycosis occur many times more often;
Infection of the amniotic membranes (chorioamnionitis, amnionitis) and the fetus itself may occur. In this case, by the way, the only thing that can save the child is just fungicides, in particular fluconazole in shock dosages;
Premature births occur quite often, which is fraught with subsequent illnesses for mother and child. The first occurs due to a failure in the hormonal part of the reproductive cycle, the second due to the imperfection of a number of systems (depending on the specific timing of prematurity);

Premature birth causes various endocrinological pathologies of the mother, which quite often leads to the appearance of benign (fibroids, fibroids) and malignant tumors of the uterus, appendages, and mammary glands.

Candidiasis increases the risk of intrauterine oxygen deficiency, which is one of the most common problems of miscarriage and developmental defects in newborns;
Refers to one of the causes of premature rupture of water. This, in turn, increases the risk of infectious damage to the membranes and fetus, up to sepsis and death of the child (and sometimes the mother);
The risk of early postpartum infection in a woman in labor increases.

So, on the one hand, there are proven risks from taking a 20-fold dose of fluconazole in animals, on the other hand, there are absolutely reliable statistics on miscarriages and diseases of mother and child from widespread fungal infections, and the latter looks much more impressive.

This does not mean that for every episode of thrush in a pregnant woman, the doctor will prescribe fluconazole, but one thing can be said for sure - if the spread of infection is suspected or if the mother’s initially weak immunity, this is completely justified. In such cases, you should not make a scandal by pointing to the instructions for the drug - the main task of the doctor is to prevent the most dangerous scenario for the mother and child.

How does Fluconazole affect the fetus?

Women are recommended to take this drug only when the likelihood of fetal pathologies from a fungal infection is greater than from the use of the medication. Data from US scientists suggests that pregnant women receiving the drug in doses of 400 mg or higher in the first trimester are at risk, since the drug can lead to many abnormalities in fetal development, including: abnormalities of the cardiovascular system, cleft palate or lesions liver, deformities of the limbs, skull, rebbe or bones of the baby.

Treatment with Fluconazole

Reviews about Fluconazole during pregnancy are varied, both positive and negative. Some doctors believe that this drug should never be used during pregnancy, regardless of the stage of pregnancy.

Other gynecologists allow Fluconazole to be taken during pregnancy in a dosage that is safe for the unborn child. When prescribing, they must take into account the duration of pregnancy, since the dosage when taking the drug in each trimester is different.

Fluconazole when planning pregnancy

If thrush appears in a woman intending to become pregnant, it is not recommended to take Fluconazole tablets. Once in the body, the drug is cleared from the plasma within 60 hours, and completely from the body in 14 days. If thrush appears and the decision was made to use an antifungal drug, then it is better to wait until conception. You need to consult a gynecologist. He or she may suggest another non-pregnancy medication to treat thrush.

How to avoid thrush?

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If a woman had to deal with genital candidiasis before pregnancy, then she needs to be very careful about her body when this condition occurs. After all, treatment will consist of taking strong antifungal drugs, for example Fluconazole.

To the question whether it is possible to take Fluconazole during pregnancy, unfortunately, the answer is negative. So, the basic rules when planning pregnancy:

It is necessary to cure candidiasis in advance. After completing the course of therapy, take a smear to confirm that the disease has been cured and you can begin planning your pregnancy.
When pregnancy occurs, a woman must regularly visit her gynecologist and follow all recommendations regarding nutrition.
During intimacy, be sure to use a condom to reduce the likelihood of infection with a fungus.

It is also recommended that women take medications that may aggravate candidiasis with caution.

Contraindications

The drug is not used for:

high individual sensitivity to the components of the drug;
simultaneous use of Terfenadine (unacceptable with a dose of Fluconazole of 400 mg or more);
the use of Cisapride, Astemizole and other drugs that affect the QT interval;
breastfeeding;
liver diseases.

Price

Fluconazole can be bought in the online store by ordering the necessary medicine through the catalog. You can also read customer reviews on the manufacturer’s website. It is better to compare the cost of Fluconazole by checking out the offers in different pharmacies. The price varies depending on the dosage of the drug (amount of active substance), manufacturer (domestic or foreign) and the form of the drug. The drug is prescribed after consultation with a specialist.

The drug Fluconazole (150 mg)	Manufacturer	Price, in rubles
Capsules	Ozone	20
Capsules	Vertex	20
Capsules	Replex Farm	28
Shtada, capsules	Nizhpharm	64
Capsules	Darnitsa	80
Teva, capsules	Teva Pharmaceutical	151
Sandoz, capsules	Sandoz	156
Pills	Technologist	54

Destination Features

The dosage of the drug and the duration of its use are determined by the attending physician, taking into account the condition of the pregnant woman and the fetus, the presence of concomitant pathologies, the possibility of developing side effects and other factors.

Before prescribing an antimycotic, it is advisable to conduct a microscopic examination of a smear from the woman’s genital tract, since secondary bacterial infections often appear against the background of candidiasis. This situation requires additional use of antibiotics for complete treatment.

Thrush often appears in the middle of the menstrual cycle during ovulation, which is associated with hormonal changes in the body. In this case, the medicine should be taken once in a standard therapeutic dose of 150 mg (depending on the weight, condition of the patient and other parameters, the dose can be 50-300 mg per day).

If candidiasis during pregnancy has recently occurred in an acute form, then a single dose of 150 mg of the drug is also prescribed (usually drinking just 1 capsule of fluconazole helps to achieve the desired effect).

If thrush has a chronic course and is difficult to treat, then a course of antifungal therapy consisting of several doses of Fluconazole capsules will be required.

Relief of symptoms occurs after about 2-3 days. If this does not happen, you should consult your doctor again to adjust the treatment.

Intravenous administration of the drug during pregnancy is sometimes prescribed, but only for strict health reasons.

Analogs

There are many drugs produced around the world with active ingredients similar to Fluconazole, all of which are prohibited for use by pregnant women. There are no safe analogues, even if customer reviews say otherwise. If thrush occurs during pregnancy, gynecologists recommend other drugs that are not capable of causing harm to the mother and fetus. Direct analogues of Fluconazole, which have the same active substance, include: