Prevention of oropharyngeal candidiasis in immunocompromised patients (receiving chemotherapy or radiation for cancer or corticosteroids for cancer or transplant).
Action⬆⬇
Affects the permeability of the fungal cell wall, allowing leakage of cellular contents.
Therapeutic effects:
Decrease in or prevention of symptoms of oropharyngeal candidiasis.
Pharmacokinetics⬆⬇
Absorption: Minimal systemic absorption.
Distribution: Inhibitory concentrations remain in saliva for up to 3 hr after troche dissolves.
Metabolism/Excretion: Metabolized by liver; <1% excreted unchanged in urine.
Half-Life: 24 hr.
Time/Action Profile⬆⬇
ROUTE
ONSET
PEAK
DURATION
PO
unknown
unknown
up to 3 hr
Contraind./Precautions⬆⬇
Contraindicated in:
Hypersensitivity;
Systemic candidiasis.
Use Cautiously in:
Hepatic impairment;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Safety not established in breastfeeding;
Pedi: Children <3 yr (safety and effectiveness not established).
PO (Adults and Children ≥3 yr): Treatment: One troche 5 times daily for 14 days; Prophylaxis: One troche 3 times daily for the duration of chemotherapy or until steroid doses are ↓ to maintenance levels.
Availability⬆⬇
(Generic available)
Troches: 10 mg
Assessment⬆⬇
Assess oropharyngeal mucosa before and periodically during therapy.
Monitor for signs/symptoms of systemic mycoses during therapy. If systemic mycoses suspected, treat as indicated with systemic antifungal.
Lab Test Considerations:
Monitor hepatic function prior to and periodically during therapy. May ↑ AST.
Implementation⬆⬇
PO: Allow each troche to dissolve slowly in mouth to achieve maximum effect.
Patient/Family Teaching⬆⬇
Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Advise patient to notify health care professional if original symptoms of oropharyngeal candidiasis persist or worsen during therapy.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.
Evaluation/Desired Outcomes⬆⬇
Decrease in or prevention of symptoms of oropharyngeal candidiasis.