Thrush / Candida in the system and Prednisolone

I was told yesterday that last week's Gastroscopy showed that I had some thrush (candida) in the oesophagus and in the stomach. I had been given fungilin lozenges to dissolve in my mouth but have now been prescribed something rather more potent as the biopsies showed considerable (moderate to severe) Oesophagitis and gastric reflux. The only symptoms of this to me are chest pains at the moment.
I have a question to other Forum members if they have ever had to take Fluconazole whilst on Pred. I will repost what I posted on the local Wegener's FB forum here in case someone somewhere else has experience with the interactions of these drugs. Below are the details. Thanks for your help :)

Well here's a new conundrum. I just managed to get the new meds for the Thrush a product called Fluconazole Sandoz 100mg. I am to take 2 tablets day one then 1 daily for 2 weeks. As I want to figure out the best time of day to slot this in given all the other stuff i take I checked it out carefully on the internet. As usual the list of potential side effects is quite hair raising anyway ... I am beginning to get used to ignoring those just printed out the list for Dennis as the majority if you get them require immediate action i.e. another visit to ER. So Dennis can monitor me. LOL some of the "more common" side effects are stomach pain and heart burn. Just what I need an extra dose off.
However what is really frustrating is this drug comes with a huge number of other meds that are contraindicated. Luckily most of them I don't take. I am now thankful I am on Insulin and not oral diabetic tablets for instance. But guess what. Predninsone / Prednisolone is on the list. Furthermore it states on another website that a) the interaction increases the potency of BOTH drugs b) you need to have regular blood tests to monitor the effect and c) the interaction is SIGNIFICANT and requires close monitoring by your doctor. They tell you to make sure you take a list of all vitamins and drugs you take to your doctor. Well I do that for every visit with every doctor I see. But not all of them use the computer to verify. My old GP had a computer system which would warn him the minute he prescribed something that had an issue with what I was already taking and with my medical history. The Gastroenterologist pulled out a book to check the angina tablets she ordered but I didn't see her check the book for this Fluconazole.
Well I was told to take it for 2 weeks. Was not told about any monitoring required. Was told to let my GP manage the Oesophagitis in future. Was not told who would check if the 2 weeks got rid of the thrush. It's not as if I can see it myself, being in my stomach and oesophagus.
So now I am in a fix. Do I just ignore all this given that I ignore a lot of warnings on packages as I realise mainly it's there to protect THEIR hide in case of litigation. Or do I put off taking it and double check with WHOM??? Rheumy??? GP ???? both of which have already prescribed stuff contraindicated for people on some of the meds I am on (one example being the MTX and the Bactrim) so chances are they may not even know this level of detail.
Question here ... has anyone else taken Fluconazole and Pred together? I am not too worried about it increasing the potency of the Pred for 2 weeks. Guess I am used to higher doses of that stuff. Not sure though how nasty the Fluconazole is likely to get as a result of the pred and 20 mg a day of pred is still considered a fairly high dose. I'll post this on the global forum as well just in case someone there has some info. Guess one option is to go back to the lozenges for now and wait until I have more info from the Rheumy at least, if I can get a hold of him.

Hi Inge, maybe checking with your pharmacist would be a good idea. Sometimes docs figure that the contraindications with certain meds fall into an acceptable range. As far as checking with a doc, I would check with the doc that prescribed it if you don't like the info from the pharmacist.

A couple of years ago I took this med for the same reason, but was on it a month. I wasn't on pred at the time, but I had NO reactions to it. Good luck.

I just got scope on both ends yesterday and the surgeon said it looks like I also have esophageal thrush or candida esophagitis but have to wait for biopsy results next week to confirm it. I have had a sore throat for awhile and thought it was probably the post nasal drip from sinus damage causing it but decided to get scope when I had trouble swallowing and even pain when i sneezed.

I have had scopes in past checking for stenosis but they found my throat was irritated from GERD acting up and upped my pantoprazole meds which seemed to reduce the GERD and allowed the throat to heal.

I have several risks for developing esophageal thrush such as having diabetes, taking the generic Fosomax (alendronate sodium), having GERD which is made worse by prednisone, taking antibiotic trimethoprim long term (non sulfa part of Bactrim), and like everyone else having a weakened immune system from Wegs and taking azathioprine.

The surgeon who did the gastroscope said he doesn't treat it and referred me to an internist for treatment. He did acknowledge that with my history and current meds treatment might be a a bit of a challenge. I wonder if thee is another specialist that has more expertise in this area?

I already take some meds that are not recommended to be taken together but understand your concerns about doing so. I also wonder at which point they "dangerous combinations" might just show themselves as causing some serious problems. I am going to ask my doctors about going off the generic Fosomax and trimethoprim since I can't do anything about the diabetes and am more fearful about stopping the azathioprine and pred.

The fungus becomes very serious if it gets into our general system. Respiratory complications being one risk I can't afford. So how do we control it without causing ourselves more problems.

I guess it is just another complication of Wegs we have to learn to deal with. It is also like our diabetes in that the disease itself is not likely to kill us directly but the complications of the disease and/or its treatment may well do so.

There are web sites that allow checking for drug interactions and my pharmacist uses one for all my new meds but how severe the side effects or non recommended interactions may be are unpredictable.

Did the lozenges help any? How will they check for success of treatment?

Thanks Cindy and drz. I did a bit more research and had some replies on the Australian FB group page so in the end I felt comfortable enough to start the dose.
a) The recommended dose for adults is 50 to 400 and as mine is 200 day 1 and 100 mg each day for 2 weeks this falls well below the max recommended and even if the prednisolone fortifies the drug this means I should still be safe with it.
b) Debra one of the Aussie members posted as follows:
There was a case report that a liver- transplanted patient treated with prednisone developed acute adrenal cortex insufficiency when a three month therapy with fluconazole was discontinued.
The discontinuation of fluconazole presumably caused an enhanced CYP3A4 activity which led to increased metabolism of prednisone.
Patients on long - term treatment withfluconazole and prednisone should be carefully monitored for adrenal cortex insufficiency when fluconazole is discontinued. As you are on it for only 2 weeks, you shouldnt have any side effects from it from what I can see

And drz I have no idea if the lozenges helped. I started taking them straight after the Gastroscopy but the day after had these massive chest pains and again on the weekend which is why I made the follow up appointment with the Gastroenterologist. She had not even recommended making any appointment so had I not gone there on Friday would not have even had the biopsy results. She has also not mentioned that she would need to check in the future if the candida is gone. I would assume the only way they can tell is via another gastroscopy. Her main comment was get your GP to monitor your Oesophegitis. I will also discuss with my Rheumy. Drz looks like we are both challenged by the same stuff. The pred and Bactrim (I am on the Bactrim DS) the diabetes all make getting rid of the thrush or preventing a relapse more difficult. I was also advised by another Forum member to eat yoghurt regularly to control thrush so have started that again. I was having it every night for another reason (constipation) but since that problem resolved itself I was not as diligent in having the yoghurt.

In general I am not overly worried about what it says in the instructions for drugs because I know they need to cover everts situation no matter how rare or how vague so that nobody can sue them if something goes wrong. And in our case how on earth would you in any case prove it was the new drug that caused it when the illness itself is so unpredictable and can change from day to day.

Anyway I will update this thread and let you know how I go with the Fluconazole and what my other doctors have to say about it and also what anyone (if anything) thinks I need to do to check the thrush is gone :( I had that as a question to ask on Friday but forgot to write it down.

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Originally Posted by windchime

Hi Inge, maybe checking with your pharmacist would be a good idea. Sometimes docs figure that the contraindications with certain meds fall into an acceptable range. As far as checking with a doc, I would check with the doc that prescribed it if you don't like the info from the pharmacist.

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Problem is Cindy, this doctor didn't think I needed to see her again. Another specialist not so easy to get hold of although her secretary is very caring and efficient. She offered last time to ask some questions on my behalf but I said no I would rather see the doctor myself. As I have to have these blood tests done I will have to see the GP to get the results so will start with him and I see my Rheumy before I stop taking the meds so will see what he thinks but by then I should have noticed if I can cope.