Fluconazole once a week, any side effects?

Hi Xelaetaks -

I think it's great that your MD is covering the risk of yeast/fungal overgrowth. However, if you don't already have an existing yeast/fungal overgrowth, the fluconazole, which is a systemic anti fungal and works by crossing the mucosal barrier of the gut and entering the bloodstream, but this also means it has to be processed by the liver/kidneys, which can bring a little risk. And it might be overkill and a risk you don't need to take.

Also, I know some MDs pulse the anti fungal Rx but I'm not real sure this is a good idea - could build up resistance.

A few q's -
Do you currently have overgrowth symptoms? If so, can you describe them?

For someone yeast-prone, as a preventative measure w/ abx, I highly recommend PURE Nystatin powder, which is naturally-derived, it's local so it doesn't cross the mucosal barrier, which means your liver/kidneys don't have to work hard to process it, which can be problematic and require support and monthly testing to watch enzyme levels.

There is a LOT more info in this thread, if you're interested. Give it a read and then we can help you with specific questions -
Y/FO in New to Lyme? thread at top of page:
www.healingwell.com/community/default.aspx?f=30&m=1606610&g=3644275#m3644275

Regarding die-off -
If you have an existing overgrowth issue, you'll probably feel some immediate reaction to taking an anti fungal. You should also make sure you have excellent detox protocols in place before you take an anti fungal - so the dead debris don't spend more time in your body than necessary. And always implement a sugar-free, simple-carb-free diet or the anti fungals will not work and you run the risk of building resistance to antifungals.

If you don't have a significant overgrowth issue, you might not notice too much in die off symptoms.

The Nystatin powder is MUCH simpler and easier use since you can start with low doses and slowly titrate to optimal doses. It also hits y/f on contact in mouth and throat, which the pills cannot do.

Please let us know if you have more questions -

-p

Pirouette said...
Hi Xelaetaks -

I think it's great that your MD is covering the risk of yeast/fungal overgrowth. However, if you don't already have an existing yeast/fungal overgrowth, the fluconazole, which is a systemic anti fungal and works by crossing the mucosal barrier of the gut and entering the bloodstream, but this also means it has to be processed by the liver/kidneys, which can bring a little risk. And it might be overkill and a risk you don't need to take.

Also, I know some MDs pulse the anti fungal Rx but I'm not real sure this is a good idea - could build up resistance.

A few q's -
Do you currently have overgrowth symptoms? If so, can you describe them?

For someone yeast-prone, as a preventative measure w/ abx, I highly recommend PURE Nystatin powder, which is naturally-derived, it's local so it doesn't cross the mucosal barrier, which means your liver/kidneys don't have to work hard to process it, which can be problematic and require support and monthly testing to watch enzyme levels.

There is a LOT more info in this thread, if you're interested. Give it a read and then we can help you with specific questions -
Y/FO in New to Lyme? thread at top of page:
www.healingwell.com/community/default.aspx?f=30&m=1606610&g=3644275#m3644275

Regarding die-off -
If you have an existing overgrowth issue, you'll probably feel some immediate reaction to taking an anti fungal. You should also make sure you have excellent detox protocols in place before you take an anti fungal - so the dead debris don't spend more time in your body than necessary. And always implement a sugar-free, simple-carb-free diet or the anti fungals will not work and you run the risk of building resistance to antifungals.

If you don't have a significant overgrowth issue, you might not notice too much in die off symptoms.

The Nystatin powder is MUCH simpler and easier use since you can start with low doses and slowly titrate to optimal doses. It also hits y/f on contact in mouth and throat, which the pills cannot do.

Please let us know if you have more questions -

-p

Thanks. I have a lot of fatigue and headaches symptoms but I can't say if that is candida over say lyme disease or anything else. I don't know if I have specific candida symptoms but I do have a very sensitive stomach and digestive issues as well.

I've taken tons of natural anti fungals and wonder if they have any comparison to nystatin? Cause the naturals haven't really seemed to help too much.

I have a feeling my candida would possibly be systemic at this point? I don't know how you would know anyway honestly.

I also do plan to go on a strict diet once I start taking abx and anti fungals soon. Also my llmd said with once a week it shouldn't be a problem but I have heard about how hard it is on the liver.

X -
True, fatigue and headaches could be from various issues. And agree that "sensitive stomach and digestive issues" can be a sign of y/f overgrowth.

Please read the thread I posted - has a few more answers for you. The systemic Rx like Fluconazole and the Nystatin powder (not necessarily the pill or liquid forms, which are filled with fillers and a lot less of the actual Nystatin) are stronger than the naturals. This is why the naturals don't work well for resolving a pre-existing y/f overgrowth issue and with long-term use amidst an overgrowth problem, the yeast can grow resistant.

The risk with GI problems if you think you have an overgrowth issue is that yes, "leaky gut" can lead to systemic problems. But not knowing details of your GI problems, it's tough to say if this is the issue. There is more about this in that thread.

It would be very beneficial to start the strict diet now - will help you start detoxing, which will help lessen the impact of the antifungals and abx.

-p

1000Daisies said...
I definitely knocked mine back when generic version of diflucan did nothing for me. So, I do believe naturals can be effective, albeit tricky. But as you know, I am not out of the woods yet, as I still am striving for a 'negative' culture test.

OK… here's where we get into the dirty details! I think it's great that you had so much success w/ naturals. Over the years, I have seen others report the same. My previous statement might a little too definitive for some people and that's OK.

Rules of Thumb
The reason I usually tell people to go straight to Nystatin is to hit the yeast/fungal overgrowth a little harder, faster with something that, in my research, seems to be more reliable (particularly when you're providing info to people on a blog like this, w/out a lot of background).

The GI damage w/ y/f overgrowth can be severe and probably more destructive to Lyme tx than anything else and when people have used naturals for a long time unsuccessfully (otherwise, they wouldn't have a pre-existing issue) or don't know they have an overgrowth issue, the urgency is to stop the growth immediately to repair the damage.

The info I've found suggested Nystatin was more reliable across the board when you're not specifically sure what you're fighting. I generally don't recommend people use the systemic antifungals right off the bat because they are more specific to strains (which is why Diflucan never worked for you, didn't work for me all the time). And, they are harder on the body and require monthly bloodwork. But with systemic issues, they are helpful to some. My Doctor's Data stool test showed 6 or so natural antifungals that were not effective against my strain(s), nor was Diflucan, Itraconazole, etc.

I also emphasize Nystatin because it's "one-stop-shopping" for y/f overgrowth. There are quite a few posters here who are new to just about everything. New to Lyme, certainly, but also new to herbal protocols, a different kind of diet, testing, natural doctors… and taking Nystatin is a lot simpler to the brain amidst our overwhelming treatment, than learning natural antifungals, what they do, where to find them, how to rotate them, etc. So I admit I emphasize Nystatin for those reasons, too.

Y/f overgrowth sleuthing can be pretty complicated… and nothing anyone is doing for Lyme & Co is a panacea for everyone. But hopefully these rules of thumb are helpful for most.

-p

Post Edited (Pirouette) : 4/18/2017 11:41:19 AM (GMT-6)

Pirouette said...
X -
True, fatigue and headaches could be from various issues. And agree that "sensitive stomach and digestive issues" can be a sign of y/f overgrowth.

Please read the thread I posted - has a few more answers for you. The systemic Rx like Fluconazole and the Nystatin powder (not necessarily the pill or liquid forms, which are filled with fillers and a lot less of the actual Nystatin) are stronger than the naturals. This is why the naturals don't work well for resolving a pre-existing y/f overgrowth issue and with long-term use amidst an overgrowth problem, the yeast can grow resistant.

The risk with GI problems if you think you have an overgrowth issue is that yes, "leaky gut" can lead to systemic problems. But not knowing details of your GI problems, it's tough to say if this is the issue. There is more about this in that thread.

It would be very beneficial to start the strict diet now - will help you start detoxing, which will help lessen the impact of the antifungals and abx.

-p

It seems like maybe nystatin is the way to go. Is it something that can be taken once a week or integrated with an antibiotics protocol?

One thing that bothers me about fluconazole is the risk for heart issues. It sounds like it's pretty rare but that side effect kept me from trying it months ago even.

Can nystatin also be ordered online? If not I can ask my doctor. I feel like I'm asking them a lot of requests in our first month but I guess that
could happen when treating lyme and coinfections.

Also I have had gut issues for a while which gi doctors couldn't even diagnose with colonoscopys so I think the idea that the gut could be a source for this sounds interesting. Plus if candida can't be seen with a colonoscopy that could add more possibility for it to be true with me and perhaps lyme as part of it as well.

Thanks

Hi X -

In your situation, I think you might do very well to test out the Nystatin powder. No, it's not something you can take only once a week (for a couple reasons I'm not a fan of people doing that with the systemics, either).

Please ask your MD for a prescription for PURE Nystatin POWDER, 1,000,000 units daily dose. Clarify that you are not looking for the (blue) pills, or the liquid suspension (made for kids, 1/3 sugar), but the pure powder. You can share this dosing information w/ him:
drmyhill.co.uk/wiki/Nystatin_-_how_to_take_it

You'll likely need to fill the Rx at a compounding pharmacy - if you don't have one near you, I can recommend one or you can look online - many ship, some for free. Or post and ask for recommendations.

You can get this powder from a foreign pharmacy w/out a prescription but it's quite expensive.

Please do not be shy about asking for information, support from your MD. They work for you and this is a very normal and critical part of Lyme treatment. You are not like their other patients. As long as you are always courteous, patient, clear in your requests, and follow up, they should help you in every way they can—you're going to need a LOT of support. If they balk at providing these full services, they might not be a good partner for you.

Yeast and fungal issues are yet another reality for us treating Lyme that the medical industry understands little about. I don't know if y/f can be observed through colonoscopy but the problem might be more that if the technicians aren't directed to look for it, and don't know how to identify it, it won't be found, even if it's there. And the medical industry generally dismisses the reality of y/f as an underlying problem for GI distress.

In my many, many years of GI problems, I have learned that it's usually not just one thing. Really short cliff notes: I have a DNA mutation that altered the gut bacteria, creating an environment that was more favorable for problems. It may have taken a few years, but eventually, y/f overgrowth and other gut dysbiosis (probably damage from gluten and maybe other things) created damage to the mucosal lining, which caused leaky gut, which launched me into years of severe food allergies, malabsorption, pain when eating, adrenal and thyroid distress, etc… and all of these problems were cyclic, causing even more GI distress.

While I made huge improvement treating y/f overgrowth, it took awhile and other measures to heal my gut. Once my gut started to heal, the other body systems that were contributing to GI distress also started to get better. So as complicated the ratcheting down process of GI dysfunction… the opposite was also true. Required a lot of juggling of issues.

And at a certain point after things started to improve, my reaction to treatment also improved. Luckily, my LLMD waited to start treatment until I had made some progress. So, while it often starts with something like y/f overgrowth, the solution is often much broader.

Good luck - please let us know how things are going.

-p

Post Edited (Pirouette) : 4/20/2017 12:37:53 PM (GMT-6)

Hi cindy -

Yes, you need to be on an anti fungal full-time until you can get it back under control and I also think you should stay on it while you're on abx. 3 abx is a LOT. I understand the concern with the liver - systemic antifungals can really tax the liver on top of everything else in our treatment. For those who need the systemics - please support your liver with milk thistle seed and burdock root.

For you, here are a few options:

For maximum effect, take the diflucan for another couple weeks since you know it works and once the yeast/fungus is under control you can stop it. But also, add in the Nystatin powder (w/ the diflucan) as more of a long-term anti fungal while you're on abx.

Nystatin generally doesn't get processed by the liver because it generally doesn't cross the mucosal lining of the gut (unless you have GI damage, which most people who have had untreated yeast/fungal overgrowth for a long time usually have). So, your liver is very safe w/ Nystatin powder.

Or - simply try out the Pure Nystatin powder now, stay on it while you're on abx and forget the diflucan.

Also, you're doing great but you really must take another step with your diet and fully eliminate all sugars and simple carbs. Even fruit. Not forever, but just until you get the yeast well under control (which can take a couple months). It's actually best if you wait until you're off antibiotics altogether before incorporating fruit or simple carbs.

Your body treats flours, white rice and potatoes (simple carbs) no different than straight sugar and no anti fungal can compete with those foods feeding the yeast at exponential speed. It's also possible for the yeast to become resistant to the antifungals if you continue to feed it while using the Rx.

I'm not a fan of pulsing antifungals. I know MDs do this but I think it's smarter, safer, more effective to be on the right anti fungal full-time while on abx. For people with existing yeast/fungal issues, this is the Nystatin powder. For others who haven't developed any overgrowth, natural antifungals are pretty successful.

The diflucan 6 days in a row is better than one day a week, as long as you remain sugar-free while on abx. And for some people, a common Rx like diflucan is easier to deal with than to use the Pure Nystatin powder (some MDs aren't familiar w/ it and refuse to learn about it, some insurance companies won't cover it, some people don't understand what commanding pharmacies are all about or don't want to or can't order it online, etc…)

But if you don't have a systemic issue, you really don't need the systemic antifungal like diflucan.

Aso, there are multiple strains of yeast and not every Rx and natural anti fungal is effective against them. Most MDs don't know this, either. My Doctor's Data stool test showed 3 common Rx and several natural antifungals were effective against my bad yeast strains. But not all are tested by the labs, so sometimes you have to try things out. If you start the Nystatin, save the GSE until you go back off the Nystatin - you don't want it to become ineffective.

-p

Post Edited (Pirouette) : 4/20/2017 12:17:44 PM (GMT-6)

Hi Cindy -

I think you're probably right - she's unfamiliar with yeast and is prescribing diflucan because it's what most MDs do. My LLMD and her nurse, both who are very open and experienced, also didn't know about it. I hope she is intrigued by the powder option.

Read the yeast/fungus post in the "New to Lyme?" thread and this might help you confirm you don't have systemic issues (I'm with you - I doubt that you do) and also help you have an informed conversation w/ her. Nystatin is derived from the earth and quite safe to take daily.
www.healingwell.com/community/default.aspx?f=30&m=1606610&g=3644275#m3644275

Please let us know how it goes! Email me if you would like a name of a "no-Rx" pharmacy.

-p

Pirouette said...


And at a certain point after things started to improve, my reaction to treatment also improved. Luckily, my LLMD waited to start treatment until I had made some progress. So, while it often starts with something like y/f overgrowth, the solution is often much broader.

Good luck - please let us know how things are going.

-p

Thanks. I spoke to their office today and they think I should start with the fluconazole. She said I should take it every day or every other day. She also mentioned that a lot of times patients too both so by the next appointment it's possible that could be added in.

My dose of fluconazole I think is 100mg a day so maybe that isn't a high dose? I have a feeling I may as well try it and see how I feel on it. I'm starting to do a more strict diet now to help with my reaction to antifungals when I start.

Pirouette said...
X -

Awesome.

You are correct - the typical fluconazole dose is a single 200mg dose per day.

But, if you have 100mg tablets, this can be convenient for you to split up at first in case your herx from die off is significant. You can take one 100mg tablet the first and second days. Then take one 100mg in AM, plus a second 100mg at night for the 3rd and 4th days. Then if you're managing die off OK, take two 100mg tablets once per day. If you don't have much die off - go ahead and start with two 100mg tablets at the same time.

You also start the Nystatin powder with small doses and work higher.

-p

Thanks P. I will keep that in mind. Do you think I can start with 50mg or rather start with 100mg?

Hear that. I just meant if taking that low a dose would cause resistance or something. My pills are 100mg so I guess it wouldn't be hard to split one.

Thanks! I'll probably try at 50 first and if it's not bad I think that'll help my confidence for upping it.