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What Causes Pain On The Sides Of The Tongue While On Fluconazole?

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Posted on Wed, 6 Apr 2016
Question: Hi again! Thank you for your help with the Thrust migrating to the esophagus. I've been taking 100 mg of Fluconazold / day since Monday, 1.4.
Most of my symptoms are gone, but the sides of my tongue are excruciatingly painful. This is slightly better, but just slightly.
I finally ate some scrambled eggs this morning. Otherwise, it's been yogurt, Boost & pudding all week. Lots of water. I have to deal with the tongue pain immediately! I can't afford to lose any weight.
What do you recommend?
Thanks for everything.
-- XXXX
doctor
Answered by Dr. Panagiotis Zografakis (50 minutes later)
Brief Answer:
the fluconazole dosage should be increased

Detailed Answer:
Hello XXXXXXX

my first comment is that the least recommended dosage for fluconazole (for esophageal candidiasis) is 200mg, so if the thrush has indeed migrated to your esophagus (was an upper endoscopy done?) then more fluconazole would have to be taken.

Regarding your mouth symptoms, has your doctor established the diagnosis of candidiasis? If it's candidiasis then you can only take the antifungal in the right dose and the symptoms will get better. Your doctor has to make sure than no other disorder (like vitamin deficiency) is causing this pain.

Kind Regards!


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (18 minutes later)
Yes! I had a feeling I should be taking more Fluconazole. I go to a clinic. My doctor is a 4th year resident and I really like her. But I know she is extra cautious. She has underprescribed for me in the past.

She is hard to reach. I am going to go up to 200 mg. But also let her office know.

1/ should I take both tablets at the same time, or can I take 1 now to speed this up? And then the other @ bedtime?.

2/ will taking the correct amount of the medication reduce the tongue soreness?

Thank you so much.

Laurel Dann
doctor
Answered by Dr. Panagiotis Zografakis (2 minutes later)
Brief Answer:
you can take them at the same time

Detailed Answer:
Fluconazole is usually taken as a single dose but dividing it wouldn't hurt!
The correct dosage would make your tongue better sooner, IF candidiasis is the cause of your complaints. That's why I've emphasized that your doctor should make sure, it's only candida.

Regarding fluconazole dosage in general, please be ascertained that 200mg is not a very high dose. Perhaps your doctor has only diagnosed oropharyngeal candidiasis. 100-200mg are enough for oropharyngeal candidiasis. At least 200mg are required for esophageal involvement.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (11 days later)
I visited my doctor Friday, 1.8. She was fine with the 200 mg of Fluconazole and suggested that I use the Fluconazole suspension as a "swish", swallowing it if that worked. She also gave me magic mouthwash with lidocaine.
My mouth hurt much less so I started eating more. But I had a couple of scary gagging episodes.
Not right after meals. Just random. I know that vomiting can be a side effect of this medication.
I also know it's way too soon to stop it.
I'm thinking I stop the swishing and cut back to 100 mg. I have to do something: I am afraid to eat! Do you think regular tiny portions of food might help?
Thank you so much!
Laurel Dann
doctor
Answered by Dr. Panagiotis Zografakis (35 minutes later)
Brief Answer:
if it's persistent then you should do some tests

Detailed Answer:
Hello again,

I'm glad to know that your mouth is doing better, which means that the treatment was effective but you have to complete it to avoid recurrences. If this side effect (probably) seems to be persistent then I would advise you to do some tests for the liver and the kidneys, just in case... SGOT, SGPT, ALP, gamma-GT, urea and creatinine should suffice. If everything is OK then you can try an alternative formulation. You can stop the suspension (although it's better because it acts both locally and systemically) and try pills. I would recommend 200mg. If you can't tolerate it then perhaps you can try itraconazole or other alternatives.

I don't believe it makes any difference with the food. If you experience GERD (reflux) then eating tiny portions helps. Otherwise it's irrelevant.

I hope everything goes fine with the rest of the treatment!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (18 minutes later)
It's not GERD. It's a sudden heaving, close to vomiting. It happened once when I doubled the pills from 100 mg to 200 mg. And then once yesterday, a couple days after I began swishing and swallowing the suspension.

I believe my system (I am 70 and weigh 71 pounds) just can't handle the larger dosage.

Since my symptoms have mostly dissapated, I have to try 100 mg -- which I took for a week and did not make sick. Please tell me this is worth a try.

Thanks again,

Laurel Dann
doctor
Answered by Dr. Panagiotis Zografakis (3 hours later)
Brief Answer:
if you can't stand it, there is no choice...

Detailed Answer:
You're welcome!

OK... if you're sure that it's the drug that makes you feel sick then there is no other choice than to choose an alternative or reduce the dosage. For oropharyngeal candidiasis (mouth and throat) 100mg should be enough. For esophageal candidiasis it's doubtful though.

You can try it anyway!
I hope it works!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (1 hour later)
Thank you! OK. My plan is 1 100mg pill and 1 swish a day. If my tongue starts sceaming, i'll add another pill.

I think I was swishing like 5 times a day.

This feels like a saner plan, right??

I've been sick since 12.24.14! Shingles, reflux, thrush. I'm desperate to get better. I'll do what I have to do.

I'lll go to 2 pills now.i trust you.i fear the swishing may be too much. But I'll still use it fot the denture soak.

Better plan?
doctor
Answered by Dr. Panagiotis Zografakis (10 minutes later)
Brief Answer:
Your plan sounds OK but there is an alternative

Detailed Answer:
Of course you can try the single pill and swish approach. Since you're having a long standing problem though, I would suggest an alternative. You can discuss it with your doctor, if you'd like. Itraconazole solution 200mg per day for at least a couple of weeks. Please keep in mind that fluconazole is the primary regimen and itraconazole an effective alternative.

Those choices are almost equivalent, so you can pick any of them.

Kind Regards!
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3810 Questions

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What Causes Pain On The Sides Of The Tongue While On Fluconazole?

Brief Answer: the fluconazole dosage should be increased Detailed Answer: Hello XXXXXXX my first comment is that the least recommended dosage for fluconazole (for esophageal candidiasis) is 200mg, so if the thrush has indeed migrated to your esophagus (was an upper endoscopy done?) then more fluconazole would have to be taken. Regarding your mouth symptoms, has your doctor established the diagnosis of candidiasis? If it's candidiasis then you can only take the antifungal in the right dose and the symptoms will get better. Your doctor has to make sure than no other disorder (like vitamin deficiency) is causing this pain. Kind Regards!