Issue link: http://cp.revolio.com/i/869597
Page 42 | Abby's Magazine - www.AbbysMag.com In August 2011, the FDA changed the classifica on of Fluconazole (Brand Name: Diflucan), a commonly prescribed an fungal medica on taken orally for the treatment of vaginal yeast infec ons, to a Category D drug. This means that there is evidence of human fetal risk but that benefits may warrant use of the drug in pregnant women only when medically necessary. Yet it is s ll commonly prescribed. Fluconazole has been found to cause birth defects in infants born to mothers who took it in high doses (400-800 mg/day) during the first trimester of pregnancy, confirmed again recently in a review done in Denmark using na onal health registries to review outcomes in each pregnancy in which a prescrip on for oral fluconazole was filled a er the sixth week of pregnancy. These were matched with up to four pregnancies without fluconazole exposure. Over 1.4 million pregnancies from 1997 through 2013 were reviewed. Miscarriage occurred (between 7 and 22 weeks' gesta on) significantly more o en in exposed than unexposed pregnancies. The oral drug (compared to vaginal inser on) was associated with significantly higher risk of miscarriage. Previous research has suggested a link between high-dose oral fluconazole therapy and congenital malforma ons. Birth defects included brachycephaly (short, broad head), abnormal facial structure, abnormal skull development, cle palate, bowing of the femurs, thin ribs and long bones, arthrogryposis, and congenital heart disease. It is usually only used in such high doses for women who are immunocompromised – for example, with HIV/AIDS or who are undergoing chemotherapy – and develop a systemic fungal infec on. For otherwise healthy women, a yeast infec on is anything but life threatening – though when bad it can feel like there's a red alert going on down there! Typical dosing of fluconazole for common vaginal yeast infec ons is 150 mg as a one- me dose. The FDA stated that the risks do not appear to be associated with this single 150-mg dose. At this dose, the drug remains category C, which means there are no adequate studies in humans and, although studies of animals have shown an adverse effect on the fetus, poten al benefits may warrant use of the drug in pregnant women despite poten al risks. There are few published studies of in utero exposure to low doses of fluconazole. While most showed no consistent pa ern of abnormali es, the studies have been too small to accurately detect an increased risk for major birth defects overall and none of the studies were large enough to accurately detect an increased risk for rare or unique birth defects or syndromes. Given the iden fied risks of high doses, and the uncertain safety of typical doses, I find it hard to understand why a vulnerable popula on – pregnant women and their babies – con nue to be exposed to a poten ally risky pharmaceu cal treatment at any dose when simple, safe, and effec ve remedies for common vaginal infec ons are available. Diflucan has been a medical mainstay for trea ng vaginal yeast infec ons for decades. For your garden-variety infec on, a single dose at 150 mg might do the trick. For many women, however, more than one dose is needed. I don't know about you ladies, but the thought of taking a drug that is associated with birth defects, even if rare, makes me consider the alterna ves – whether I'm pregnant or not. Read Trea ng Vaginal Infec ons Naturally for more informa on on natural approaches. References Di e Mølgaard-Nielsen, MSc; Henrik Svanström, PhD; Mads Melbye, MD, DrMedSci; Anders Hviid, MSc, DrMedSci1; Björn Pasternak, MD, PhD. Associa on Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abor on and S llbirth. JAMA. 2016;315(1):58-67. D o n ' t U s e t h i s M e d i c a t i o n i n P r e g n a n c y D o n ' t U s e t h i s M e d i c a t i o n i n P r e g n a n c y