Can Fluconazole Cause Dizziness?
Yes, fluconazole can cause dizziness, and this is a recognized adverse effect listed in the FDA drug label. 1
Direct Evidence from FDA Labeling
The FDA-approved prescribing information for fluconazole explicitly warns that:
- Fluconazole can cause dizziness and seizures 1
- Patients are specifically advised not to drive or operate machinery until they know how fluconazole affects them 1
- Dizziness is listed among the most common side effects of fluconazole tablets 1
Clinical Context and Frequency
Dizziness appears to be a relatively common adverse effect in clinical practice:
- In long-term fluconazole therapy studies, fatigue (which often accompanies dizziness) occurred in 11.3% of patients receiving prolonged treatment 2
- In one clinical trial for cutaneous leishmaniasis, a patient discontinued fluconazole specifically due to malaise, headache, and moderate dizziness (grade 2 adverse event) 3
- Historical reviews of fluconazole adverse effects consistently list dizziness among the recognized side effects 4, 5
Additional Neurologic Considerations
Beyond simple dizziness, fluconazole can cause more serious neurologic effects:
- The FDA label warns about potential seizures in addition to dizziness 1
- Other azole antifungals in the same class (particularly voriconazole) are known for neurologic and ophthalmic adverse events 6
- Rare cases of neurotoxicity manifesting as confusion or delirium have been reported with azole antifungals 6
Clinical Implications
When prescribing fluconazole, counsel patients about:
- The possibility of dizziness as a side effect 1
- Avoiding driving or operating heavy machinery until they understand how the medication affects them 1
- The need to report persistent or severe dizziness, especially if accompanied by other neurologic symptoms 1
If a patient develops significant dizziness on fluconazole:
- Consider dose reduction, particularly in patients on higher doses (>6 mg/kg/day), as adverse effects correlate with higher dosing 2
- Evaluate for other contributing factors or drug interactions, as fluconazole inhibits multiple cytochrome P450 enzymes 6
- In cases requiring therapeutic intervention, approximately two-thirds of patients experiencing adverse effects may need dose adjustment, discontinuation, or switch to alternative antifungal therapy 2