Fluconazole Does Not Cause Nasal Congestion
Fluconazole is not associated with nasal congestion as an adverse effect. The most common side effects of fluconazole are gastrointestinal (nausea, vomiting), headache, skin rash, and rarely hepatotoxicity—but respiratory symptoms like nasal congestion are not documented adverse effects of this antifungal medication.
Common Adverse Effects of Fluconazole
The established side effect profile of fluconazole includes:
- Gastrointestinal symptoms are the most frequent adverse effects, including nausea and vomiting 1
- Headache occurs commonly in patients receiving fluconazole 2, 3
- Skin reactions including rash and pruritus may be observed, with rare cases of Stevens-Johnson syndrome reported 1
- Hepatotoxicity: Asymptomatic transaminase elevations occur in 1-13% of patients receiving azole drugs, with rare cases of fatal hepatitis 1
Why Congestion Is Not Listed
Multiple comprehensive guidelines and pharmacology reviews consistently document fluconazole's adverse effect profile without mentioning nasal congestion or any upper respiratory symptoms 1. The drug reviews from 1990-1995 that established fluconazole's safety profile specifically catalogued adverse events and did not identify respiratory congestion as a concern 4, 5, 2, 6, 3.
Clinical Considerations
If a patient on fluconazole develops nasal congestion, alternative explanations should be considered:
- Underlying fungal infection: The infection being treated (such as oropharyngeal candidiasis) may have associated symptoms 1
- Concurrent conditions: HIV/AIDS patients often have multiple concurrent infections that could cause respiratory symptoms 1
- Drug interactions: Fluconazole inhibits cytochrome P-450 enzymes, and interactions with other medications should be evaluated 1
- Coincidental viral upper respiratory infection unrelated to fluconazole therapy
The development of nasal congestion in a patient taking fluconazole should prompt evaluation for causes other than the antifungal medication itself.