Usage
- Fenticonazole nitrate is prescribed for the treatment of vulvovaginal candidiasis (vaginal yeast infection), a common fungal infection caused by Candida albicans. It is also effective against other fungi and yeasts, including dermatophytes (such as Trichophyton, Microsporum, Epidermophyton), and has shown some activity against Gram-positive bacteria and Trichomonas vaginalis.
- Pharmacological Classification: Antifungal (Imidazole derivative).
- Mechanism of Action: Fenticonazole inhibits the synthesis of ergosterol, a crucial component of the fungal cell membrane. This disruption leads to increased permeability of the fungal cell wall, causing cell death. Additionally, it inhibits the secretion of aspartic proteases by Candida albicans, which contributes to its pathogenicity.
Alternate Names
- Fenticonazole nitrate.
- Brand Names: Lomexin, Gynoxin, Fentizol, Fentisoft, Novofenti.
How It Works
- Pharmacodynamics: Fenticonazole exerts its antifungal effect by primarily targeting ergosterol synthesis, a critical component of fungal cell membranes. This leads to increased cell wall permeability and ultimately fungal cell death. Additionally, it inhibits the secretion of acidic proteases by Candida albicans.
- Pharmacokinetics: After vaginal administration, systemic absorption is negligible (around 0.58% to 1.81% of the administered dose). This low systemic absorption minimizes the risk of systemic side effects. Metabolism and elimination pathways are not well-characterized due to the minimal absorption, but it’s likely that whatever small amount gets absorbed will go through hepatic metabolism and renal excretion.
- Mode of Action: At a molecular level, Fenticonazole inhibits the enzyme lanosterol 14α-demethylase, which is essential for ergosterol biosynthesis. It also interferes with the activity of cytochrome oxidases and peroxidases.
- Elimination Pathways: Due to low systemic absorption, information on specific elimination pathways is limited. Hepatic metabolism and renal excretion are likely involved for the small fraction that’s absorbed.
Dosage
Standard Dosage
Adults:
- 200 mg vaginal capsule: Insert one capsule deeply into the vagina at bedtime for three consecutive nights.
- 600 mg vaginal capsule: Insert one capsule deeply into the vagina as a single dose at bedtime.
Children:
- Not recommended for children under 16 years of age. For adolescents above 16, the adult dosage applies.
Special Cases:
- Elderly Patients (over 60): Use with caution under the supervision of a physician.
- Patients with Renal Impairment: No dose adjustment is typically needed due to minimal systemic absorption. However, caution is advised and supervision from a physician is necessary.
- Patients with Hepatic Dysfunction: No dose adjustment is typically needed. However, it is recommended to use with physician supervision.
- Patients with Comorbid Conditions: Consideration and appropriate adjustments should be based on a comprehensive patient assessment.
Clinical Use Cases
Fenticonazole is specifically indicated for vulvovaginal candidiasis. It’s not systemically administered, so it’s not relevant in scenarios like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dose adjustments are not typically necessary due to the minimal systemic absorption following vaginal administration.
Side Effects
Common Side Effects:
- Local irritation (burning, itching, redness) at the application site.
Rare but Serious Side Effects:
- Allergic reactions (rash, hives, swelling, difficulty breathing).
Long-Term Effects:
- Data is limited due to short-term treatment duration.
Adverse Drug Reactions (ADR):
- Severe allergic reactions.
Contraindications
- Hypersensitivity to fenticonazole or other imidazole antifungals.
Drug Interactions
- May damage latex contraceptives (condoms, diaphragms). Alternative contraceptive methods should be used during treatment and for a few days afterwards.
- Spermicides: Concurrent use is not recommended as local vaginal treatment may inactivate spermicides.
- Limited data on other drug interactions due to low systemic absorption. However, it is essential to inform the doctor of all current medications.
Pregnancy and Breastfeeding
- Pregnancy: Limited data available. Use only if clearly necessary and under strict medical supervision. The applicator should not be used during pregnancy.
- Breastfeeding: Limited data available. Use only if clearly necessary and under strict medical supervision.
Drug Profile Summary
- Mechanism of Action: Inhibits ergosterol synthesis, disrupts fungal cell membrane.
- Side Effects: Local irritation, rarely allergic reactions.
- Contraindications: Hypersensitivity to fenticonazole or imidazoles.
- Drug Interactions: May damage latex contraceptives, spermicides.
- Pregnancy & Breastfeeding: Use with caution if clearly needed and under medical supervision.
- Dosage: 200 mg/day for 3 days or a single 600 mg dose, vaginally.
- Monitoring Parameters: Resolution of symptoms.
Popular Combinations
Not applicable for this locally acting medication.
Precautions
- Discontinue use if hypersensitivity or allergic reaction occurs.
- Avoid concurrent use of latex contraceptives, spermicides and other vaginal products.
- Avoid sexual intercourse during treatment and for a few days after.
- Maintain good hygiene to prevent re-infection.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Fenticonazole?
A: Adults: 200 mg vaginally once daily for 3 days or a single 600 mg dose. Not recommended for children under 16.
Q2: How does Fenticonazole work?
A: It inhibits ergosterol synthesis, disrupting the fungal cell membrane and causing cell death.
Q3: What are the common side effects?
A: Local irritation, burning, itching, and redness.
Q4: Can I use Fenticonazole during pregnancy?
A: Only if absolutely necessary and under strict medical supervision.
Q5: Can I use Fenticonazole while breastfeeding?
A: Only if absolutely necessary and under strict medical supervision.
Q6: What should I do if I miss a dose?
A: Do not double the dose. Continue with the next scheduled dose.
Q7: Can I use Fenticonazole with condoms?
A: No, Fenticonazole can damage latex condoms. Use alternative contraceptive methods.
Q8: How long does it take for Fenticonazole to work?
A: Most patients experience symptom relief within a few days.
Q9: What if my symptoms don’t improve after treatment?
A: Consult your physician for further evaluation and treatment.
