Trichomoniasis, caused by the parasite Trichomonas vaginalis, is a common sexually transmitted infection (STI) that affects millions of people worldwide. For those grappling with the symptoms of this often-painful infection, Flagyl (metronidazole) emerges as a crucial ally in the battle against Trichomoniasis.
Flagyl, an antibiotic medication, is renowned for its effectiveness in treating a variety of bacterial and parasitic infections, including trichomoniasis. The mechanism of action of Flagyl against Trichomonas vaginalis involves disrupting the DNA and cellular structure of the parasite, ultimately leading to its demise.
For individuals suffering from trichomoniasis, the symptoms can be debilitating. From genital itching and burning to painful urination and unusual discharge, the impact of this infection on one’s quality of life can be profound. However, with Flagyl, there is hope.
Upon commencing treatment with Flagyl, individuals often experience a significant improvement in their symptoms. The medication works diligently to eradicate the parasite, alleviating discomfort and restoring a sense of normalcy to their lives. In most cases, a single dose of Flagyl is sufficient to combat the infection, although some individuals may require a longer course of treatment depending on the severity of the infection.
Beyond its immediate impact on symptoms, Flagyl plays a crucial role in preventing the spread of trichomoniasis. By effectively eliminating the parasite from the body, Flagyl reduces the risk of transmission to sexual partners, helping to curb the spread of this STI within the community.
However, while Flagyl is a powerful weapon against trichomoniasis, it is not without its limitations. Like all medications, Flagyl may cause side effects in some individuals, including nausea, vomiting, and diarrhea. Additionally, some individuals may experience an allergic reaction to the medication, necessitating immediate medical attention.
Furthermore, it is essential to complete the full course of Flagyl as prescribed by a healthcare professional, even if symptoms improve before the medication is finished. Failure to do so could result in a recurrence of the infection, potentially requiring further treatment.
In conclusion, Flagyl stands as a beacon of hope for those grappling with the challenges of trichomoniasis. With its potent antimicrobial properties and proven efficacy, Flagyl offers a path to healing and recovery for individuals affected by this insidious infection. Through diligent adherence to treatment guidelines and close collaboration with healthcare providers, individuals can overcome trichomoniasis and reclaim their health and well-being.
In the quiet solitude of his dimly lit room, Adam, a 30-year-old man, sits with a heavy heart and a mind clouded by melancholy. His thoughts drift back to a time when passion flowed effortlessly, and the touch of his lover ignited a fire within him. But now, a shadow looms over his once vibrant intimacy – erectile dysfunction (ED).
Adam’s journey with ED began unexpectedly, casting a pall over his romantic endeavors. Despite his youthful vigor and desire, his body betrayed him, leaving him feeling inadequate and disconnected from his partner. The weight of disappointment and frustration grew heavier with each failed attempt at intimacy, pushing him further into a realm of desolation.
In his quest for a solution, Adam turned to tadalafil, a beacon of hope in his sea of despair. The small pill promised to restore his confidence and revive the passion that had slowly faded away. With cautious optimism, he embarked on this new chapter, hoping for a reprieve from the darkness that had enveloped him.
As he took the medication, Adam felt a glimmer of anticipation, a flicker of hope that perhaps, this time, things would be different. Slowly, but surely, the effects of tadalafil began to manifest. His body responded to the slightest touch, and the once elusive erection became a reality once more.
Yet, amidst the physical resurgence, Adam found himself grappling with emotions that lingered like a stubborn fog. The specter of ED still haunted him, casting doubts on his masculinity and leaving scars on his psyche. The intimacy he once cherished now felt like a performance, a facade to conceal his inner turmoil.
Despite these challenges, Adam persevered, finding solace in moments of fleeting connection with his partner. He learned to embrace vulnerability, understanding that true intimacy transcends physicality. With each passing day, he grew stronger, reclaiming his sense of self and redefining his understanding of love and intimacy.
Today, Adam’s journey with ED continues, a constant ebb and flow of emotions and experiences. Yet, through it all, he remains steadfast, a testament to the resilience of the human spirit. And though the road ahead may be uncertain, Adam walks it with a newfound sense of purpose, knowing that he is not alone in his struggle.
In the end, Adam’s story is not just one of triumph over adversity, but a poignant reminder of the complexities of human experience. It is a story of love, loss, and resilience, a testament to the indomitable nature of the human heart. And as Adam looks to the future, he does so with hope in his heart, knowing that whatever may come, he is stronger for having faced his demons head-on.
Today I will tell you about the cialis product … Today, men over 40 generally have sexual reluctance or erectile dysfunction. 4 or 5 days ago, when I was talking to my 43-year-old friend, the topic came to sexuality.
He talked about how he overcame his sexual reluctance, and I will briefly tell you the subject from his mouth. He started researching on the internet because he had not been together with his wife for about 6 months and this situation became annoying, and as a result, he started to use the cialis 100 mg product. Sex drive started 45 minutes after taking the first cialis product. He mentioned that the erection problem was over and the sexual intercourse was taking too long. My friend, who said that it was very affordable in terms of price, told us that the cialis tablet adds color to his life. We strongly recommend that you buy cialis products from reliable cialis companies or pharmacies on doctor’s recommendation.
Due to many reasons, most men have erectile dysfunction. The penis, which cannot reach sufficient hardness for sexual intercourse, causes problems between couples and creates a serious psychological trauma for the man. It is produced to eliminate this problem with the ingredients contained in Cialis. It allows the penis to harden half an hour after use.
Cialis Increases the Pleasure From Sexual Intercourse.
Cialis enables the veins on the penis to expand and the blood flow in these veins to accelerate. With the widening of the vessels, the pleasure of men who use Cialis increases even more.
Cialis Effect Lasts for 36 Hours.
After taking Cialis, its effect on the body continues for 36 hours. However, using more than one during the day is inconvenient and causes undesirable negativity.
How to Use Cialis?
Cialis is produced in capsule form. It should be swallowed with a glass of warm water half an hour before sexual intercourse. It takes effect within half an hour after use and makes the penis reach enough hardness for sexual intercourse.
What are the harms of Cialis?
The active ingredient in Cialis is tadalafil. Using more than the recommended dose creates adverse effects.
There is also a risk of heart attack in men who use Cialis, due to the ingredients found in it. For this reason, Cialis should only be used under the supervision of a doctor and is available on prescription.
What is erection (hardening) medicine?
In today’s meaning, “drugs that provide erection” or “erection drugs” mean drugs that provide erection and facilitate sexual intercourse by increasing blood flow to the penis, the male sexual organ, to the physiological mechanism of erection. These drugs are also medically referred to as “Phosphodiesterase 5 Inhibitors” because they inhibit the action of phosphodiesterase 5, an enzyme that plays a role in erection (penile hardening) on the penis.
Who can use erection medication?
Medicines are considered first-line treatment for erection. The random use of this drug by a person who does not know his general health condition may cause some unwanted problems.
People using long- or short-acting nitrate-containing drugs
People without serious cardiac disorders
People who have not had myocardial infarction in the last 6 months
Those who do not have severe liver and kidney failure
They are usable drugs suitable for all kinds of patients without retinitis pigmentosa.
On the other hand, caution should be exercised in the use of drugs used in the treatment of some viral diseases and a doctor’s recommendation should be sought.
Are there any side effects of erection medication?
People who do not have risk factors and all age groups can use erection drugs. However, those in the young age group generally use erection drugs as performance enhancing drugs. Common side effects of all erection medications:
Hot flushes
Palpitation
Headache
Dizziness
Defect of vision
Sweating
Anorexia
Nose fullness
Pain in the back and leg muscles
It usually has minimal side effects, such as a feeling of redness on the face.
However, the use of erection drugs by a person who does not know his general health condition, such as a hidden cardiac disease, may cause cardiac problems and sudden cardiac death.
On the other hand, in the young age group, using high doses or accidentally overdose may cause prolonged erection, ie priapism, although very rarely. Therefore, it is recommended to be used with caution, to be used under recommendation, and to be used in low or average doses if used as a performance enhancer in the young age group.
The purpose of erection drugs that block the enzymes that prevent erection is to increase the blood supply in the penis. Different ingredients are used to achieve this. As an active ingredient:
Tadalafil
Vardenafil
Sildenafil
Avanafil
Udenafil
Lodenafil
There are medications that contain mirodenafil.
In terms of interaction, only the initial times, interactions with food and duration of action of these drugs are different. Their effectiveness and side effects are similar.
In our country, there are Sildenafil, Vardenafil, Tadalafil and Avanafil in the order of launch of these drugs. While the drugs containing the active ingredient Vardenafil and Sildenafil act quickly, their duration of action is shorter than the others. Drugs containing Tadalafil and Avanafil, on the other hand, provide a later erection, while the duration of action is longer than the others.
Can erection medications available on the Internet cause health problems?
Erection drugs sold on the Internet can cause serious health problems not only in our country but also in the whole world. These types of drugs constitute over 70-80% or even nearly 90% of the pharmaceutical market in third world countries. In these erection medicines, which are extremely problematic in terms of reliability and whose contents are not known, sometimes ingredients containing deadly substances can also be used.
The most innocent harm of erection medications available online may be that they do not contain active ingredients. These drugs, which can contain extremely harmful toxic substances, should be avoided.
If erection medications do not work, what are the methods that can be applied?
If the drugs do not work, it should be questioned whether they are used properly or not. For example, Sildenafil-containing drugs have an interaction with food. It can have a negative effect especially when used with fatty foods. Therefore, it is recommended to use on an empty stomach. Tadalafil, on the other hand, does not have such an interaction.
The second important factor is that the testosterone level must be normal for erection drugs to work. If erection drugs do not work, it may be necessary to check the testosterone level, if there is a testosterone deficiency, this problem must be corrected first and then the drug should be restarted.
Dosage can be increased. If the dose used is insufficient for the patient, it can be switched to an alternative dose.
Although it does not have much meaning, it can be changed in the erection medicine used. Although there are drugs in the same group, sometimes different drugs may give different results with placebo effect psychologically.
In the patient group who do not respond to them and cannot use them, other treatment methods should be turned to.
Could erection medication be used together with alcohol be troublesome?
Simultaneous use of erectile drugs with alcohol creates problems, as is the case with all drugs. In addition to decreasing the effect of the drug, it increases the liver toxicity and increases the side effects. On the other hand, sildenafil and vardenafil are less effective with alcohol, while tadalafil has no interaction with alcohol.
What are the foods that provide erection?
Aphrodisiac foods can be used to ensure erection. The most well-known among the aphrodisiac foods is ginseng. Apart from this, fruits such as avocados and strawberries can also have an aphrodisiac effect.
A diet consisting of plenty of vegetables, fruits and fiber will be beneficial for sexual life. Increasing sexual desire; It may be beneficial to consume certain aphrodisiac foods. These foods both play a role in providing energy needs, and provide control of the hormonal level (testosterone level) and thus increase libido. In addition, it has vasodilating effects, especially increasing blood flow in the penis.
If we need to group some of the foods that increase sexual power by grouping:
Vegetables:
Garlic; Thanks to a substance called “allicin”, it is effective in increasing the blood flow of the penis.
Asparagus: It is rich in B vitamins.
Broccoli: It has a rich vitamin C content. It is an antioxidant effective and increases libido.
Hot pepper: Thanks to the “capsaicin” it contains, it both increases blood flow and stimulates the release of endorphins, the happiness hormone.
Maca radish: Maka Radish, a South American plant such as hot pepper or Chili pepper, is widely consumed mainly in Peru.
Carrot: It is a rich source of vitamin A.
Lentils and legumes: Contains protein, fat, carbohydrates and vitamin B1, sodium, calcium and iron.
Fruits:
Avocado; It increases the level of testosterone through vitamin B6. It also plays a role as an energy source thanks to its folic acid content.
Watermelon; Thanks to the citrulline amino acid, it increases the blood supply of the penis by expanding the blood vessels.
Blackberry: The chemicals in its content play a role in increasing sexual desire.
Peach: Increases blood supply. It has a high content of C-vitamins. In this way, it has an antioxidant effect.
Grapefruit: Increases sexual power with its vitamin C content. However, grapefruit juice reduces the effectiveness of erection medications. For this reason, erection medications are not recommended to be taken with grapefruit juice.
Apricot: Contains vitamin A and potassium.
Olive: It is an important aphrodisiac with its rich mineral content as well as vitamins A, C and E.
In addition to these, figs, apples, grapes, strawberries, bananas are other aphrodisiac fruits.
Nuts and grains etc. foods:
Ginseng: Increases blood flow and increases sexual desire.
Pumpkin seeds; Pumpkin seeds containing vitamins B, E, C and K increase the level of testosterone and control sexual desire.
Peanuts; It increases the blood circulation of the sexual organ by relaxing the blood vessels with the intense amount of arginine amino acids it contains.
Hazelnuts: It is rich in fiber, protein and minerals.
Pumpkin seeds: Rich in zinc, potassium and calcium. It is anti-oxidant effective. It improves sperm quality. It keeps the cholesterol level in balance. In this way, it plays a role in adjusting the testosterone level and in the regulation of libido.
Saffron: It has been an aphrodisiac spice since ancient times.
Almond: It has a rich zinc content. In addition to increasing the level of testsoteron, it also improves sperm quality.
Clove: It is a powerful aphrodisiac known since ancient times.
Ginger: It is vasodilating and anti-oxidant effective.
Oats: The L-arginine it contains increases the nitric oxide level and thus blood supply.
Pine nut: With its intense L-arginine content like oats, it increases the level of nitric oxide and increases blood supply.
Cardamom: It regulates blood flow with the chemical called cineole.
Cinnamon
Sea products:
Oyster; It regulates the libido by increasing the dopamine level.
Shrimp.
Caviar: It has an antioxidant effect with its zinc content. It controls the testosterone level. It is effective on libido and sperm production.
Others:
Chocolate: Its main ingredient, cocoa, is mainly an anti-oxidant effect. In addition, it increases endorphin release and stimulates libido and sexual pleasure with the phenyletlamine contained in it.
Egg: With its rich protein and B vitamin content, it both meets the energy needs and increases the libido.
Molasses: It is important in meeting the energy need with the calcium and potassium it contains, and in meeting the oxygen demand of the tissues with iron.
Tadalafil is an oral medication used to treat erectile dysfunction in men.
Tadalafil is an oral medication used to treat erectile dysfunction in men. It should only be taken in low doses per day when sexual intercourse is expected or if regular sexual intercourse is expected. This drug is a phosphoesterase type 5 inhibitor. This class includes other drugs such as sildenafil and vardenafil.
Erectile dysfunction, impotence, affects many men and is dependent on a number of both physiological and psychological factors. The physiological process of obtaining and maintaining an erection is complex and involves various chemicals and nervous system signals. Cyclic (cyclic) GMP is one of the chemical messengers involved. When sexual stimulation occurs, GMP is released and causes the blood vessels in the penis to dilate, providing more blood circulation and helping the penis harden.
Phosphoesterase type 5 is another chemical messenger that cleaves cyclic GMP. Tadalafil prevents the breakdown of cyclic GMP by inhibiting Phosphoesterase type 5. This ensures a sustainable erection. The drug only works when sexual stimulation occurs because cyclic GMP is only available then.
Tadalafil can be used “as needed”. When used in this way, the pill is taken about half an hour before the expected sexual intercourse. Usually the prescriber will start with a low dose of 10mg and increase it to 20mg if necessary depending on the response and tolerance.
Erectile dysfunction can be distressing and causes considerable anxiety. Tadalafil can also be taken in a daily dose if regular sexual intercourse is expected, thus eliminating the need for anticipatory dose. But when used daily, the dose is much lower, either 2.5 mg or 5 mg depending on the response and tolerance.
As with any medication, tadalafil can interact with other medications or medical conditions. It should not be used with any nitrate medication, which is a common medication for angina patients. Before using tadalafil, any accompanying medication or illness should be discussed with the prescribing doctor to avoid potentially dangerous interactions.
Tadalafil can cause side effects. The most common of these are dizziness, headache and postural hypertension, especially in patients taking concomitant antihypertensive drugs. Due to the possibility of dizziness, patients should not drive or work with heavy machinery while on the way to work after taking the drug. Rarely, priapism may occur. This means an erection that lasts longer than four hours and requires medical treatment to prevent long-term damage to penile tissues.
Cialis 100 mg 30 tablets is the highest dose of cialis products. Byusing cialis 100 mg for users who cannot get effective in Cialis 20 mg, it eliminates the relationship problem between their partners and provides an erection between spouses. With the development of modern medicine, the problem of erection is no longer a nuisance and has eliminated the sexual problems of men. Cialis products are not suitable for people under the age of 18, and it has been deemed appropriate for users over 18 years of age to be given by a doctor’s prescription.
Cialis
Tadalafil, sold under the patent of Cialis, is an effective medication used to treat pulmonary arterial hypertension and benign prostatic hyperplasia. It is a tablet product that is taken orally. Cialis Effect takes effect within 30 minutes on average and is effective up to 36 hours.
The drugs under the name Cialis , which stands out as sexually effective, are not only used by men who want to have a happy night. It is also a known development that Cialis products are also used for medical purposes. Cialis, which was released after long-term research and color the sexual lives of people, is also an important detail in eliminating the health problems of people. Cialis for those dealing with prostate problems and seeking solutionsIt is at a level that can meet the sufficient conditions. By showing how effective it is in case of regular use; In this sense, it is at a level that can offer the required standards to the users. In addition to being able to meet the desires of each user, it is also addressed in prostate treatment.
General Use of Cialis
General use of Cialis is focused on sexuality. At this stage, it is also in a very effective place in achieving such results that users will be satisfied with. While every man is in a highly active place, it will also have an impact on the users’ always achieving the results they want. Cialis eliminates the problem of impotence with its general use. At the same time, it can show how important it is for the users to be highly effective and unlimited. In this way, men have an important place in terms of pleasing both themselves and their partners.
Is Cialis Harm?
Cialis will not cause any harm and this will only take shape with correct use. However, it is also necessary to read the prospectus and enter into the necessary researches in the period before starting this phase of use. Every user who moves in this direction can be seen continuously as a result of achieving their goals. On the other hand, it stands out as a recommended condition that people who do not have chronic diseases such as cardiovascular diseases should use Cialis pills. In this way, it is seen that men create reasonable situations for problems such as premature ejaculation or inability to erect. Every man does not have a problem in shaping his sexual life for a long time.
It is known that most people display timid attitudes when purchasing Cialis products that are considered to be sexually supportive. As a prominent result, they generally obtain Cialis medicines from websites instead of buying them from pharmacies. Although it is known that all men act in this direction, acting in this way can be in the direction of risk from time to time. They should also go into research on the fact that the websites are reliable and the prices match the determined figures. It should be an important choice for men to become active again and use original Cialis drugs in this sense. In this way, it will be seen how assertive they are in achieving exactly the results they expected.
How to Detect Original Cialis?
From time to time, counterfeit drugs that provide sexual activity and that are stated to eliminate health problems are found in the market. It is also necessary to be careful not to come across fake versions of Cialis products. The status of the websites and their standards should be issues that need to be addressed in the purchasing process. It is perfectly normal that there is still a doubt when the medicines are delivered. It is also important for users faced with such a situation to consider whether their medicine containers are worn or torn. In this way, they will find the right drug and will start to have the chance to continue their sexual life actively again.
How to Use Cialis Products?
The use of Cialis products is extremely simple. It is stated that these drugs should be consumed with plenty of water. It is also stated that it is necessary to take food before consuming Cialis pills. In this way, if there is a stimulant, it will be able to take effect within half an hour. It is stated that it should be taken once a day because it will be effective in the long term. The use of Cialis is in this direction for every man to have an effective sexual life. In this way, Cialis will be able to bring its effect to life in eliminating the functionality of the male genital areas. It has an important place in reviving the old days again, with a focus on ensuring that men are in completely different moments.
Thrush is a fungal disease caused by the candida fungus. Viral pathogens are not irritants. The treatment of candidiasis is complicated, so you should contact your local gynecologist at the first discomfort.
Where candida can live
It affects various organs and systems. There is candidiasis of the mouth, fingers, skin, genitals. In all cases, the same causes lead to its formation, so the causative agent is candida fungus. Symptoms of disease in such cases are different and depend on the place of localization.
Symptoms of vaginal thrush
The most common symptom is itching. It occurs immediately and lasts until the start of medication. Candidiasis in women have similar symptoms, and the causes may be different. They may be bothered by white discharge from the vagina, an unpleasant, sour smell. Burning and irritation may appear on the inflamed mucosa.
Test for thrush: sit down in a chair, throw your leg over your leg. If there is the disease, the woman will feel a strong itching in the vaginal area.
Other signs of pathology:
A cottony, white-colored discharge;
Sometimes flaky masses are secreted from the vagina;
the volume of the white discharge increases after intercourse or at night;
swelling and redness of the large and small vaginal lips;
Soreness and threading during sex and urination.
Sometimes the disease occurs in a mild form, bringing almost no discomfort. The severity of symptoms depends on the individual characteristics of the body. Candidiasis in women may arise from environmental factors, but they can be infected from a man, and the partner signs during this period may be absent.
How to diagnose thrush
When examining the mucous membrane of the vagina, it can be seen that there is epithelium, which is peeling, and there is a white plaque on the mucous membranes. The gynecologist necessarily takes a woman’s smear for flora. With thrush, the pathogen called candida fungus is found.
How to properly treat thrush
Candidiasis is a disease that is accompanied by strong vaginal discharge, so it is necessary to clean the mucosa from bacteria. To do this, use such solutions for irrigation: Tantum Rosa and Citeal. These products are best suited, because they are designed specifically for use in gynecology. In addition, you can buy chlorhexidine in the pharmacy or use decoctions of chamomile or calendula. Before you start treating candidiasis with herbal remedies, you should always test for allergies.
If thrush occurs very rarely, then the use of local remedies will be enough.
The treatment of candidiasis with such remedies is the safest, because the chemicals do not enter the bloodstream. All of these drugs have a similar complex of action, since they contain an antifungal component. Zalain vaginal suppositories have the most rapid recovery. The course of application is only 1 suppository at night.
The drug Pimafucin is also effective in the treatment of this pathology, and inject it into the vagina for 3-6 days. It is allowed even during pregnancy, because the female body is subject to various hormonal changes at this time.
Candidiasis disease often occurs during stressful periods. It is worth to protect your body from external irritants or to take sedatives. Clotrimazole is particularly popular because it is the longest-standing drug. One of the best representatives is a drug that Bayer produces. You can buy it in the pharmacy under the name Kanesten. It is prescribed in a dosage of 500 mg, but it only needs to be used once.
Often doctors prescribe the drug Livarol on the basis of ketoconazole. The course of its application is 10 days.
There are complex drugs that can be used not only for candidiasis. They should be used if there is no possibility to visit a doctor, and the symptoms are so confusing that it is unreal to determine the disease yourself. Such remedies include: Neotrizol, Poliginax and others, which contain an antifungal component.
All vaginal preparations should be administered while lying on the back and in the evening. After their use, it is not necessary to bathe with soapy solutions, because there is a high probability that the product will wash out and will not have a therapeutic effect. Before using vaginal tablets, you should read the instructions carefully. Most often they need to be moistened with water. If this is not done, they can cause discomfort and discomfort when inserted. There is sometimes a feeling of discomfort when taking them. If, after a certain time, the itching and burning does not disappear, you should refuse treatment with this remedy.
If the symptoms of thrush do not occur for the first time, then you need to take antifungal pills orally. Most often these are drugs based on fluconazole. If the doctor did not prescribe another scheme, you should drink 1 capsule of the drug. Its dosage in this case should be 150 mg.
In the pharmacy, many drugs from different manufacturers are sold. The highest quality medication is produced by France – Diflucan. This is an original remedy with proven effectiveness. Treatment of candidiasis with its help is always fast and safe for the body. Analogues: Fucis or Fluzac.
When it is worth going to the doctor
It is not worth abusing the treatment. If the therapy of candidiasis did not bring results, you should see a doctor.
Candidiasis should be treated by both sexual partners; the symptoms and therapy are similar to the female regimen. But a cream should be used instead of vaginal pills.
What foods protect against yeast infection?
To protect yourself from fungus, you need to take healthy foods for the body. These include:
fermented milk products;
garlic;
lingonberries;
grapefruit.
The same useful antifungal effect has red hot pepper and propolis.
How to protect yourself from vaginal candidiasis
To begin with, you need to normalize your diet. It is necessary to consume a lot of fruits, vegetables, sour milk products.
Care should also be taken when choosing lubricants for intercourse, because they must be made on a water-soluble basis. If you are allergic to latex condoms, you should switch to other means of contraception. It is necessary to be selective about vaginal sprinkling, there is no need to repeat it every day. Such a procedure can disrupt the normal microflora and provoke disease. You should not constantly change partners and have contact with untested persons.
Is your mood spoiled by unpleasant sensations and internal discomfort?
Burning and itching in the external genital area, white cheesy discharge from the vagina, soreness during sexual intercourse, pain during urination – about three quarters of the female population of the planet at least once in their lives have experienced the result of excessive reproduction in the vagina of fungi of the genus Candida. It seems that thrush is not so terrible, it does not pose a serious threat to health, moreover, according to the assurances of commercials, it can be easily cured by itself – for three days, and it “has not happened!” And a month later, again symptoms and again medications … And then life turns into a bad dream, in which you plunge more and more into the problem of discomfort in the most intimate sphere of the body, avoid sex, begin to hate your unlucky body, which cannot cope with such a trifle.
To listen to the advice of friends or see a doctor? But how often the same recommendations are heard from the lips of a gynecologist, which are known to us from commercials, advice from friends, the Internet and other sources of medical and near-medical information. Is medicine really powerless even in solving such a simple problem? Of course, not all women with thrush, or, as it is called in medical circles, vulvovaginal candidiasis, go through the described circles of hell. But in 10-20% of cases, vulvovaginal candidiasis is complicated, and fungi of the genus Candida, which have the right to live in the normal microflora of the mouth, vagina and colon, multiply with enviable constancy, leading to the recurrence of symptoms of thrush. If there are at least four such acute symptomatic episodes of the disease per year, the doctor should diagnose “chronic vulvovaginal candidiasis.” But who will count the frequency of thrush episodes? You yourself, and no one else! Tell the gynecologist that he is dealing with mushrooms, well seasoned in battles with other microorganisms and medicines, so that it will be impossible to cope with them in the usual way.
Meanwhile, there is a way to get rid of chronic, recurrent four or more times a year, vulvovaginal candidiasis. It is described in the scientific literature, contained in international clinical guidelines, and has been proven to be effective in numerous studies. In uncomplicated thrush, effective agents are used that suppress the growth of fungi, which in most cases are effective with short courses of treatment or even a single dose of the well-known and widely prescribed fluconazole (original fluconazole — Diflucan®). Sometimes (with severe symptoms of thrush), more “heavy artillery” is required, namely – to enhance the therapeutic effect, it is recommended to increase the duration of treatment, for fluconazole (the drug Diflucan®) – this means taking a second capsule of 150 mg orally 3 days after the first. If we are dealing with chronic thrush caused by the fungi Candida albicans, then when the symptoms return, it is recommended to “hit the enemy” even harder, and for Diflucan®, as a rule, it is effective to take 3 capsules of 150 mg orally with an interval of 3 days (1 , 4 and 7 days).
However, the complete removal of fungi from the body cannot be achieved with any drug, and it is not necessary: after all, they are an integral part of it. The suppression of their excessive growth when taking one or even two or three capsules of fluconazole is achieved for 1-2 weeks, followed by a gradual resumption of the fungal population, ending with a relapse of thrush. But you can not wait for a new relapse, but support the suppression of the growth of fungi with a weekly intake of fluconazole in the hope that, in the end, they will not withstand a stronger and more patient opponent. The duration of such therapy was worked out by many years of research in order to recommend a course of weekly intake of fluconazole (Diflucan 150mg) for 6 months. The main result of such treatment is the absence of the resumption of thrush for a year or more. The situation with the treatment of recurrent thrush caused by C. albicans is insidious in that the symptoms of thrush in most cases begin to subside after taking the first capsule on the second day and go away in most after the third intake of Diflucan 150 mg on the 7th day of treatment. This stage can be called “Attack”. To prevent a relapse of thrush soon after such an “Attack”, it is important not to quit treatment, but to continue the so-called “suppressive therapy” (we will call this phase “Cruise”), because if you feel well, it is difficult to force yourself to take medications for preventive purposes. Otherwise, all efforts may be in vain. This stage lasts 6 months, during which it is recommended to take Diflucan® 150 mg once a week. In order not to forget about the timely administration of the drug, you can set yourself reminders in the form of e-mail or sms. By the way, there is a special notification service on the website www.diflucan.com, where you can easily customize them for yourself.
So, health is not a joke: therefore, tune in to a serious and long course of suppressive therapy in order to get rid of thrush and discomfort once and for all.
THERE ARE CONTRAINDICATIONS. BEFORE USING IT IS NECESSARY READ THE INSTRUCTIONS.
Stahl Jessica, MD, DSc, Prof., Dept. Obstetrics and Gynecology, Ministry of Health and Social Development of the Canada
Single or multiple use of fluconazole at a dose of 50 mg does not affect the metabolism of phenazone (Antipyrine) when used simultaneously.
The simultaneous use of fluconazole with the following drugs is contraindicated
Cisapride: with the simultaneous use of fluconazole and cisapride, adverse reactions from the heart are possible, incl. arrhythmia ventricular tachysystolic type “pirouette” (torsade de pointes). The use of fluconazole at a dose of 200 mg 1 time / day and cisapride at a dose of 20 mg 4 times / day leads to a pronounced increase in plasma concentrations of cisapride and an increase in the QT interval on the ECG. The simultaneous use of cisapride and fluconazole is contraindicated.
Terfenadine: With the simultaneous use of azole antifungals and terfenadine, serious arrhythmias may occur as a result of an increase in the QT interval. When using fluconazole at a dose of 200 mg / day, an increase in the QT interval has not been established, however, the use of fluconazole at doses of 400 mg / day and above causes a significant increase in the concentration of terfenadine in blood plasma. The simultaneous use of fluconazole at doses of 400 mg / day or more with terfenadine is contraindicated. Treatment with fluconazole at doses less than 400 mg / day in combination with terfenadine should be closely monitored.
Astemizole: the simultaneous use of fluconazole with astemizole or other drugs, the metabolism of which is carried out by the cytochrome P450 system, may be accompanied by an increase in serum concentrations of these drugs. Elevated plasma concentrations of astemizole can lead to prolongation of the QT interval and, in some cases, to the development of arrhythmias of the ventricular tachysystolic pirouette type (torsade de pointes). The simultaneous use of astemizole and fluconazole is contraindicated.
Pimozide: despite the fact that there have been no relevant studies in vitro or in vivo, the simultaneous use of fluconazole and pimozide can lead to inhibition of the metabolism of pimozide. In turn, an increase in plasma concentrations of pimozide can lead to a prolongation of the QT interval and, in some cases, to the development of arrhythmias of the ventricular tachysystolic type “pirouette” (torsade de pointes). The simultaneous use of pimozide and fluconazole is contraindicated.
Quinidine: Despite the fact that there have been no relevant studies in vitro or in vivo, the simultaneous use of fluconazole and quinidine can also lead to inhibition of quinidine metabolism. The use of quinidine is associated with prolongation of the QT interval and, in some cases, with the development of arrhythmias of the ventricular tachysystolic pirouette type (torsade de pointes). The simultaneous use of quinidine and fluconazole is contraindicated.
Erythromycin: The simultaneous use of fluconazole and erythromycin potentially leads to an increased risk of cardiotoxicity (prolongation of the QT interval, torsade de pointes) and, as a result, sudden cardiac death. Concomitant use of fluconazole and erythromycin is contraindicated.
The following medicines are not recommended
Halofantrine: Fluconazole may increase the plasma concentration of halofantrine due to inhibition of the CYP3A4 isoenzyme. It is possible to develop arrhythmias of the ventricular tachysystolic type “pirouette” (torsade de pointes) when used simultaneously with fluconazole, as well as with other azole antifungal drugs, so their combined use is not recommended.
Caution should be exercised when used simultaneously with fluconazole
Amiodarone: The use of amiodarone has been associated with prolongation of the QT interval. Caution should be exercised with the simultaneous use of fluconazole and amiodarone, especially when taking a high dose of fluconazole (800 mg).
Caution should be exercised and, possibly, dose adjustments should be made while using the following drugs and fluconazole
Drugs affecting fluconazole
Hydrochlorothiazide: repeated use of hydrochlorothiazide simultaneously with fluconazole leads to an increase in the concentration of fluconazole in blood plasma by 40%. The effect of this degree of severity does not require a change in the dosage regimen of fluconazole in patients receiving diuretics at the same time, however, the doctor should take this into account.
Rifampicin: the simultaneous use of fluconazole and rifampicin leads to a decrease in AUC by 25% and the duration of T1 / 2 fluconazole by 20%. In patients taking rifampicin at the same time, it is necessary to consider the advisability of increasing the dose of fluconazole.
Drugs Affected by Fluconazole
Fluconazole is a moderate inhibitor of cytochrome P450 (CYP) isoenzymes 2C9 and 3A4. Fluconazole is also an inhibitor of the CYP2C19 isoenzyme. In addition, in addition to the effects listed below, there is a risk of an increase in plasma concentrations of other drugs metabolized by isoenzymes CYP2C9, CYP2C19 and CYP3A4, when used simultaneously with fluconazole. In this regard, caution should be exercised with the simultaneous use of these drugs, and if necessary, such combinations, patients should be under close medical supervision. It should be borne in mind that the inhibitory effect of fluconazole persists for 4-5 days after discontinuation of the drug due to prolonged T1 / 2.
Alfentanil: there is a decrease in clearance and Vd, an increase in T1 / 2 of alfentanil. Perhaps this is due to the inhibition of the CYP3A4 isoenzyme by fluconazole. Alfentanil dose adjustment may be required.
Amitriptyline, nortriptyline: increased effect. The concentration of 5-nortriptyline and / or S-amitriptyline can be measured at the beginning of combination therapy with fluconazole and one week after initiation. If necessary, the dose of amitriptyline / nortriptyline should be adjusted.
Amphotericin B: In studies in mice (including those with immunosuppression), the following results were noted: a small additive antifungal effect in systemic infection with Candida albicans, no interaction with intracranial infection with Cryptococcus neoformans and antagonism with systemic infection with Aspergillus fumigatus. The clinical significance of these results is not clear.
Anticoagulants: like other antifungal agents (azole derivatives), fluconazole, when used simultaneously with warfarin, increases prothrombin time (by 12%), which may lead to the development of bleeding (hematomas, bleeding from the nose and gastrointestinal tract, hematuria, melena). In patients receiving anticoagulants of the coumarin and indandione series and fluconazole, it is necessary to constantly monitor the prothrombin time during therapy and within 8 days after simultaneous use. You should also evaluate the feasibility of adjusting the dose of these anticoagulants.
Azithromycin: with simultaneous oral administration of fluconazole in a single dose of 800 mg with azithromycin in a single dose of 1200 mg, no pronounced pharmacokinetic interaction between both drugs has been established.
Benzodiazepines (short-acting): after oral administration of midazolam, fluconazole significantly increases the concentration of midazolam and psychomotor effects, and this effect is more pronounced after taking fluconazole orally than when using it intravenously. If concomitant therapy with benzodiazepines is necessary, patients taking fluconazole should be monitored to assess the appropriateness of a corresponding reduction in the dose of benzodiazepine. With the simultaneous use of a single dose of triazolam, fluconazole increases the AUC of triazolam by approximately 50%, Cmax by 20-32% and T1 / 2 by 25-50% due to inhibition of the metabolism of triazolam. Dose adjustment of triazolam may be necessary.
Carbamazepine: Fluconazole inhibits the metabolism of carbamazepine and increases the serum concentration of carbamazepine by 30%. The risk of developing carbamazepine toxicity must be considered. The need to adjust the dose of carbamazepine depending on the concentration / effect should be assessed.
Calcium channel blockers: Some calcium channel antagonists (nifedipine, isradipine, amlodipine, verapamil and felodipine) are metabolized by the CYP3A4 isoenzyme. Fluconazole increases the systemic exposure of calcium channel antagonists. Control of the development of side effects is recommended.
Nevirapine: Concomitant use of fluconazole and nevirapine increases the exposure of nevirapine by approximately 100% compared to control data for nevirapine alone. Due to the risk of increased nevirapine excretion with concomitant drug use, some precautions and close patient monitoring are necessary.
Cyclosporine: In patients with a kidney transplant, the use of fluconazole at a dose of 200 mg / day leads to a slow increase in the concentration of cyclosporine. However, with repeated use of fluconazole at a dose of 100 mg / day, changes in the concentration of cyclosporine in bone marrow recipients were not observed. With the simultaneous use of fluconazole and cyclosporine, it is recommended to control the concentration of cyclosporine in the blood.
Cyclophosphamide: with the simultaneous use of cyclophosphamide and fluconazole, an increase in serum concentrations of bilirubin and creatinine is noted. This combination is acceptable given the risk of increased bilirubin and creatinine concentrations.
Fentanyl: there has been a report of one death, possibly associated with the simultaneous use of fentanyl and fluconazole. The impairments are thought to be related to fentanyl intoxication. It has been shown that fluconazole significantly prolongs the elimination time of fentanyl. It should be borne in mind that an increase in the concentration of fentanyl can lead to respiratory depression.