From the FDA Drug Label
Hepatic injury: Fluconazole should be administered with caution to patients with liver dysfunction. Fluconazole has been associated with rare cases of serious hepatic toxicity, including fatalities primarily in patients with serious underlying medical conditions In cases of fluconazole-associated hepatotoxicity, no obvious relationship to total daily dose, duration of therapy, sex, or age of the patient has been observed.
- Liver Damage and Jaundice: The FDA drug label warns of rare cases of serious hepatic toxicity associated with fluconazole, but it does not specifically address the combination of fluconazole with social alcohol consumption.
- Key Considerations:
- Fluconazole should be administered with caution to patients with liver dysfunction.
- Patients who develop abnormal liver function tests during fluconazole therapy should be monitored for the development of more severe hepatic injury.
- Fluconazole should be discontinued if clinical signs and symptoms consistent with liver disease develop that may be attributable to fluconazole. Given the information available in the drug label, no conclusion can be drawn about the specific risk of liver damage and jaundice when combining long-term fluconazole use with social alcohol consumption 1.
From the Research
Drinking alcohol while on long-term fluconazole treatment can increase the risk of liver damage, but the risk is relatively low and depends on individual factors such as liver function, age, and overall health. Both fluconazole and alcohol are metabolized by the liver, which can increase the risk of liver damage when used together 2. According to a study published in 2019, weight-based fluconazole dosing did not affect the number of critically ill recipients who met the Drug-Induced Liver Injury Network (DILIN) criteria, but patients with cirrhosis or septic shock were more likely to meet these criteria 2.
Key Considerations
- The risk of liver damage from long-term fluconazole use and social alcohol consumption is increased, but the overall risk is still relatively low.
- Individual factors such as liver function, age, and overall health play a significant role in determining the risk of liver damage.
- Patients with underlying liver dysfunction, such as cirrhosis, are at a higher risk of developing liver damage when taking fluconazole 3.
- Monitoring liver function tests during fluconazole therapy is essential, especially in patients with underlying liver disease or those who consume alcohol regularly 4.
Recommendations
- Patients taking long-term fluconazole should limit their alcohol consumption or avoid it altogether to minimize the risk of liver damage.
- Healthcare providers should monitor liver function tests regularly in patients taking fluconazole, especially those with underlying liver disease or those who consume alcohol regularly.
- Alternative antifungal treatments may be considered for patients who are unable to abstain from alcohol during therapy 5.
- Patients should be aware of the potential risks of liver damage and report any symptoms such as abdominal pain, unusual fatigue, dark urine, or yellowing of the skin or eyes to their healthcare provider promptly 6.