How to Take Diflucan and Sporanox for Psoriasis
If your doctor prescribed you fluconazole (Diflucan) or itraconazole (Sporanox) for psoriasis you may ask how to take those drugs to get the most of their effects.
You may ask if it is better to take them on an empty stomach or with food? And maybe you take omeprazole or Betaine HCL which might possibly affect the bioavailability of those antifungal drugs.
And there are even more questions because the scientific data proved that even your race depends when it comes to bioavailability of the drugs.
Fluconazole and Itraconazole – both of these drugs are hard on a liver so make sure to not to take them for longer period of time than necessary and have performed blood tests for liver enzymes.
As a long-term solution for yeast infections (along with good diet of course) there is a good option – Nystatin. It is a poorly absorbed drug doing its job mostly in the digestive tract.
There is just a handful of doctors who understand the damaging effects of yeast and fungal infections on the body. Most of them think that some ringworm, skin rashes and toenail fungus is all those pathogens can do to our bodies.
But the truth is that psoriasis, cancer, asthma and virtually all chronic diseases may be directly caused or extremely aggravated by fungal and yeast infections.
Empty stomach vs. With Meal: Fluconazole and Itraconazole
The study “Influence of concomitant food intake on the oral absorption of two triazole antifungal agents, itraconazole and fluconazole” from 1994 compared the absorption of two of the most prescribed and effective antifungal drugs – fluconazole and itraconazole.
The influence of food on the pharmacokinetics of the triazole antimycotics fluconazole and itraconazole was investigated in a randomised, parallel group, single dose study in 24 healthy subjects. Each group took either a 100 mg capsule of fluconazole or a 100 mg capsule of itraconazole, pre-prandially or after a light meal or a full meal, in a three-way crossover design. Gastric and intestinal pH were measured with a co-administered radiotelemetric pH capsule, and gastric emptying time of the capsule (GET) was taken as the maximum gastric residence time of drug and food. The plasma AUC and Cmax of itraconazole were significantly different under the various conditions and the mean AUC was greatest after the full meal. The bioavailability (90% confidence intervals) of itraconazole relative to that after the full meal, was 54% (41-77%) on an empty stomach and 86% (65-102%) after a light meal. The criteria for bioequivalence were not attained. In contrast, the bioavailability (90% CI) of fluconazole relative to the full meal was 110% pre-prandially (100-115%) and 102% after the light meal (88-103%), and the criteria for bioequivalence were attained.”
The scientists concluded that fluconazole absorption does not depend on factors like stomach pH, gastric retention time or co-administered meal composition.
In other words it does not depend if you take fluconazole (Diflucan) before, with or after a meal but itraconazole (Sporanox) is absorbed much better when taken with a full meal.
Itraconazole absorption was promoted by low stomach pH, long gastric retention time and a high fat content of the coadministered meal, whereas the pharmacokinetics of fluconazole was relatively insensitive to physiological changes in the gastrointestinal tract.
Since itraconazole is usually administered with food there is a possibility of underdosage in Japanese patients because the another study stated that there were significant differences in its absorption in German and Japanese volunteers. The same study found so such problem with fluconazole.
Omeprazole and absorption of Fluconazole
Actually, this is not about the effects of omeprazole or other anti-acid drugs on absorption of fluconazole rather than the (un)importance of stomach acid for fluconazole absorption.
The effect of a reduction in the production of gastric acid on the pharmacokinetics of the antimycotic fluconazole after a single 100 mg dose was investigated in a randomized two-way crossover study with 12 healthy volunteers.
The median bioavailability ratio of fluconazole before and after omeprazole treatment was 1.00. It is inferred that there is no interference of omeprazole with the plasma pharmacokinetics of fluconazole. The findings suggest that changes in gastric pH, as in patients with AIDS or those being treated with anti-ulcer drugs, should not influence the pharmacokinetics of fluconazole.
The omeprazole treatment in 12 healthy volunteers for 7 days raised the median gastric pH from pH 1.1 to pH 4.7 (generally considered as hypochlorhydria) but this had no significant effect on the gastric emptying time (median 4.3 vs. 4.9 hours) and absorption of fluconazole.
1) Zimmermann T, Yeates RA, Riedel KD, Lach P, Laufen H. The influence of gastric pH on the pharmacokinetics of fluconazole: the effect of omeprazole. Int J Clin Pharmacol Ther. 1994 Sep;32(9):491-6.
2) Zimmermann T, Yeates RA, Laufen H, Pfaff G, Wildfeuer A. Influence of concomitant food intake on the oral absorption of two triazole antifungal agents, itraconazole and fluconazole. Eur J Clin Pharmacol. 1994;46(2):147-50.
3) Yeates RA, Zimmermann T, Laufen H, Albrecht M, Wildfeuer A. Comparative pharmacokinetics of fluconazole and of itraconazole in Japanese and in German subjects. Int J Clin Pharmacol Ther. 1995 Mar;33(3):131-5.