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Key takeaways
Fluconazole is an antifungal medication that is unavailable over the counter because it requires medical supervision due to its many drug interactions and its impact on heart and liver function.
Several prescription and nonprescription medications, such as itraconazole, voriconazole, miconazole, and tioconazole, can substitute for fluconazole.
Several natural remedies for fungal infections exist, such as probiotics and tea tree oil, but any signs of infection should be examined by a healthcare provider for proper diagnosis and prescription treatment, if necessary.
Fluconazole (brand name Diflucan) is a prescription antifungal medication approved by the U.S. Food and Drug Administration (FDA) to treat yeast infections—particularly Candida infections. The drug is available in many forms, including tablets, oral suspension (liquid), and injectable. Because fluconazole requires a prescription from a healthcare provider, people cannot access it over the counter at a pharmacy. However, there are alternatives you can explore, such as clotrimazole, miconazole, and tioconazole.
Can you get fluconazole over the counter?
According to medical experts, you cannot get over-the-counter fluconazole. “In the United States, fluconazole is a medication that can only be obtained through a prescription,” says Bharat Pothuri, MD, a board-certified gastroenterologist and founder of GastroDoxs in Houston, Texas. “This is due to the fact that fluconazole is a systemic antifungal medication that can interact with other medications and alter liver function. Therefore, medical supervision is important to use the medication properly and safely.”
Wes Ulm, MD, Ph.D., a physician-researcher at the National Institutes of Health (NIH) in the DMV area, adds that the risks of serious side effects are another reason why the antifungal drug isn’t available over the counter. He explains that due to the potential for serious side effects—particularly involving the liver and heart—healthcare providers may monitor liver function with blood tests and watch for heart rhythm issues, such as QT prolongation, a condition where a specific interval on an EKG is lengthened, which can affect heart function. “While these are relatively rare, such side effects can be serious enough as to warrant close medical attention,” he adds.
There is also the risk of drug interactions. Dr. Ulm shares the story of a patient with protein S deficiency who was taking warfarin (an anticoagulant) due to a history of deep vein thrombosis (DVT). They were given fluconazole for a histoplasmosis fungal infection while on a hiking trip.
“She eventually came to our clinic with an unusually elevated INR (International Normalized Ratio)—a metric for bleeding tendency—well beyond the therapeutic level for her warfarin,” he explains. “It turned out that her fluconazole had interfered with her hepatic metabolism (liver breakdown) of the warfarin, essentially causing an excessive blood concentration as if she had overdosed. We quickly worked to adjust her medication regimen to bring her INR back into a normal range while still treating her fungal infection.”
A few examples of common fluconazole drug interactions include:
- Certain antiarrhythmics
- Other antifungal medications
- Macrolide antibiotics
- Anti-rejection medications
- Corticosteroids
- Cholesterol-lowering medications, such as statins
- Fluoroquinolone
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Analgesics
- Blood thinners
- Diuretics (water pills)
Despite common misconceptions, fluconazole is not known to reduce the effectiveness of oral contraceptives like birth control pills.
“Fluconazole is generally very safe, but there’s always a better chance for liver functional changes to be noticed if monitoring patients, especially those with pre-existing hepatic conditions,” Dr. Pothuri says. “There are GI side effects of nausea or abdominal discomfort, and I have witnessed interactions with common medications used for acid reflux (which many of my patients have).”
Another reason you can’t access fluconazole without a prescription is the need for a proper medical evaluation and diagnosis by a healthcare provider. “A physician’s input is instrumental in confirming a diagnosis that requires fluconazole as treatment, particularly since the conditions for which fluconazole is called for—often severe fungal infections such as histoplasmosis, candida infections (including thrush or oral candidiasis), fungal meningitis, dermatophytosis, or coccidioidomycosis—can be quite serious and require close monitoring,” Dr. Ulm explains.
If you suspect you have a yeast infection or other fungal infection, it’s best to visit your healthcare provider for a proper diagnosis and a prescription for fluconazole or a similar medication to alleviate symptoms.
Risks of using fluconazole without a prescription
According to Dr. Pothuri, the known risks of taking fluconazole without a prescription or medical supervision include:
- Drug-drug interactions—particularly with statins, anticoagulants, and antacids
- Misdosing
- Misdiagnosis of an infection
- Delayed treatment of an underlying medical problem that could be more serious
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Fluconazole prescription alternatives
Fluconazole is not the only prescription medication available to treat fungal infections. If the drug is deemed unsafe or not effective enough to treat your condition, your healthcare provider may recommend one of the following prescription alternatives:
- Itraconazole (Sporanox): Treats a wide range of yeast and fungal infections.
- Voriconazole (Vfend): Treats various fungal infections.
- Nystatin (Nystop): Treats vaginal yeast infections (vaginal thrush) and fungal infections affecting the skin, mouth, and esophagus.
- Terbinafine (Lamisil), Ciclopirox (Penlac, Ciclodan): Treats toenail and fingernail fungal infections.
- Fungizone (Amphotericin B): Treats life-threatening fungal infections.
- Echinocandins (Cancidas, Mycamine, Eraxis): Treat invasive fungal infections.
- Miconazole (Oravig), Clotrimazole lozenges (Mycelex): Treats oral yeast infections (oral thrush).
“The choice of antifungal agent mostly depends on the type of fungal infection, as well as liver function and other medications that are being used before the diagnosis was made,” Dr. Pothuri says.
Fluconazole OTC alternatives
In addition to prescription alternatives, there are also over-the-counter medications that could be suitable replacements for fluconazole.
Here’s a look at nonprescription alternatives for vaginal yeast infections and toenail fungus:
Vaginal yeast infections (vaginal thrush)
Toenail fungus
- Terbinafine (Lamisil AT)
- Tolnaftate (Tinactin)
Natural alternatives to treat infections
Several natural alternatives may offer relief for mild fungal infections.
Here are a few examples:
- Probiotics or prebiotics
- Vitamin D
- Garlic
- Tea tree oil
- Oregano
- Thyme
- Peppermint
- Ginger
- Rosemary
- Honey
“Among the most common include cornstarch or baking soda as applied to feet and socks or other foot coverings, which can help absorb moisture and thus forestall the growth of the fungi that can cause athlete’s foot,” Dr. Ulm explains. “Apple cider vinegar and tea tree oil have also been noted to have more direct antifungal properties when applied topically to minor fungal infections.”
However, with natural remedies, if it’s your first time experiencing this infection, your first step should be to visit a healthcare provider. “Any serious fungal infections that would require a drug like fluconazole, such as histoplasmosis, cryptococcosis, fungal meningitis, or blastomycosis, should be treated only under the supervision of a medical professional, in which case home remedies would not be suitable,” Dr. Ulm says.
- Evaluation of interaction between fluconazole and an oral contraceptive in healthy women, Obstetrics & Gynecology (2001)
- J. Wes Ulm, MD, Ph.D, of National Institutes of Health (NIH)
- Bharat Pothuri, MD, of GastroDoxs