Published: 3 December 2020

Publications

Fluconazole – OK to use in pregnancy?

Published: 3 December 2020
Prescriber Update 41(4): 69

December 2020

Fluconazole is indicated for the treatment of fungal infections.¹ It is available on prescription and from a pharmacist as an oral single-dose treatment for vulvovaginal candidiasis (vaginal thrush).

In June 2020, the Medicines Adverse Reactions Committee (MARC) reviewed the data on fluconazole and its use in pregnancy.^2,3 This review was triggered by the results of a study by Bérard et al which concluded that:

• any maternal exposure to fluconazole in early pregnancy may increase the risk of spontaneous abortion
• doses higher than 150 mg during the first trimester may increase the risk of cardiac septal closure anomalies in the fetus.⁴

Health care professionals are reminded that when treating vaginal thrush:³

• topical treatment remains an effective first-line therapy for most pregnant women
• questions around the possibility of pregnancy should be included in routine patient counselling.

References

1. Oakley A. 2003. Fluconazole. In: DermNet NZ. URL: dermnetnz.org/topics/fluconazole/ (accessed 15 September 2020).
2. Medsafe. 2020. Medicines Adverse Reactions Committee: Fluconazole and use in pregnancy. URL: medsafe.govt.nz/committees/MARC/reports/182-3.2.2Fluconazole.pdf (accessed 15 September 2020).
3. Medsafe. 2020. Minutes of the 182^nd Medicines Adverse Reactions Committee. URL: medsafe.govt.nz/profs/adverse/Minutes182.htm#3.2.2 (accessed 15 September 2020).
4. Bérard A, Sheehy O, Zhao JP, et al. 2019. Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case-control studies. Canadian Medical Association Journal 19: 191(E179–87). URL: ncbi.nlm.nih.gov/pmc/articles/PMC6379167/ (accessed 15 September 2020).