Diflucan vs Sporanox

Listen to the article instead of reading through it.


For patients dealing with fungal infections, certain antifungal medications can assist in eradicating the infection and managing symptoms. Diflucan (fluconazole) and Sporanox (itraconazole) are two such drugs frequently prescribed for these purposes. Both of them inhibit ergosterol synthesis – a key component of the fungal cell membrane - thus destroying the fungus causing infection. Fluconazole, which is Diflucan's active ingredient, primarily works by inhibiting cytochrome P450-dependent enzyme lanosterol 14α-demethylase that catalyzes conversion of lanosterol to ergosterol. On the other hand, Sporanox's active constituent itraconazole also inhibits this enzyme but has a broader spectrum covering more types of fungi compared to fluconazole.

What is Diflucan?

Fluconazole (the generic name for Diflucan) was one of the first significant discoveries within the class of antifungal drugs known as azoles. First approved by the FDA in 1990, Fluconazole acts by preventing fungi from producing a substance called ergosterol, which is an essential component of fungal cell membranes. It's prescribed primarily for various forms of fungal infections including yeast infections and thrush. On another hand, Itraconazole (the generic name for Sporanox) also belongs to this same class but it was introduced later in 1992. Although both these drugs work similarly, their efficacy differs depending on the type and location of infection. Just like Prozac selectively influences serotonin without majorly affecting dopamine or norepinephrine, Fluconazole has a selective action against certain types of fungi with fewer side effects compared to other antifungals that have broader activity spectrum.

What conditions is Diflucan approved to treat?

Both Diflucan and Sporanox are approved for the treatment of various fungal infections:

  • Vaginal candidiasis, also referred to as yeast infection (Diflucan)
  • Oropharyngeal and esophageal candidiasis, which are throat infections caused by Candida fungus (both drugs)
  • Cryptococcal meningitis, a life-threatening brain infection (Diflucan)
  • Onychomycosis, commonly known as nail fungus (Sporanox)

How does Diflucan help with these illnesses?

Diflucan (fluconazole) and Sporanox (itraconazole) are both antifungal medications that work by inhibiting a key component of fungal cell membranes. They do this by blocking the synthesis of ergosterol, an essential component in the formation of these membranes. Without sufficient ergosterol, holes form in the fungal cell membrane causing contents to leak out, which ultimately leads to the death of the fungus.

While both drugs have similar mechanisms of action and can be used for various types of fungal infections, there are some differences between them in terms of their pharmacokinetics and side effect profiles. For instance, Diflucan is commonly chosen for its longer half-life, allowing once daily dosing whereas Sporanox often requires multiple doses per day. However, your healthcare provider will make a decision based on your specific circumstances including type and location of infection as well as other medical conditions you may have.

What is Sporanox?

Sporanox is a brand name for itraconazole, an antifungal medication that prevents fungus from growing in the body. It functions by inhibiting the fungal cytochrome P-450 enzyme 14α-demethylase, thereby preventing the synthesis of ergosterol - a key component of the fungal cell membrane. Itraconazole was first approved by the FDA in 1992. Unlike fluconazole (the active ingredient in Diflucan), itraconazole has a broader spectrum of activity against various types of fungi and is therefore used to treat many different kinds of fungal infections, including blastomycosis and histoplasmosis which are not typically responsive to fluconazole. Its side effect profile also differs slightly from that of Diflucan; while both drugs can cause nausea, diarrhea, rash, and liver toxicity, Sporanox may also lead to hypertension or heart failure in rare cases due to its negative ionotropic effect. The wider range of fungi susceptible to Sporanox makes it an effective treatment option when patients do not respond well to "typical" azole antifungals such as Diflucan.

What conditions is Sporanox approved to treat?

Sporanox, an antifungal medication, is recognized by the FDA for the treatment of various fungal infections including:

  • Onychomycosis (fungal infection in the nails)
  • Oral and esophageal candidiasis
  • Aspergillosis (for patients who are intolerant or unresponsive to other therapies)
  • Certain systemic fungal infections such as blastomycosis, histoplasmosis, and sporotrichosis.

How does Sporanox help with these illnesses?

Sporanox is a potent antifungal medication that operates by inhibiting the growth of fungi within the body, thereby helping to eliminate fungal infections. It plays a significant role in many biological processes, affecting cell membrane integrity and permeability, which are crucial for fungal survival. Just as norepinephrine impacts various bodily functions, Sporanox influences numerous fungal processes. Its action on ergosterol synthesis is particularly important in its role as an antifungal medication. Although it shares similarities with other azole antifungals like Diflucan (Fluconazole), Sporanox (Itraconazole) has a broader spectrum of activity against various types of fungi and may be chosen when patients do not respond well to typical azoles or require treatment for more resistant or diverse types of fungal infections.

How effective are both Diflucan and Sporanox?

Both fluconazole (Diflucan) and itraconazole (Sporanox) are commonly prescribed antifungal medications that have been available since the 1980s and early 1990s respectively, playing a significant role in managing fungal infections. They both work by inhibiting the synthesis of ergosterol, an essential component of fungal cell membranes. A head-to-head study comparing fluconazole to itraconazole for treating vaginal candidiasis found them to be similarly effective.

Fluconazole has been shown to be highly effective in treating many types of Candida infections including those resistant to other treatments. In a review from 2004, fluconazole was preferred over other azole antifungals due to its high bioavailability, extensive tissue distribution and predictable pharmacokinetics. Fluconazole is also less likely than some other antifungals to cause drug interactions because it does not significantly inhibit cytochrome P450 enzymes.

Itraconazole has demonstrated efficacy in treating various systemic mycoses such as histoplasmosis and blastomycosis which do not respond well or at all to fluconazoles treatment regimen. While this makes Sporanox valuable for these particular conditions, overall Itraconazoles use can sometimes be limited by its variable oral absorption especially when taken without food. Nonetheless, with correct administration - taking capsules immediately after a full meal - therapeutic plasma concentrations can often be achieved consistently.

abstract image of a researcher studying a bottle of drug.

At what dose is Diflucan typically prescribed?

Oral dosages of Diflucan for fungal infections typically start at 150 mg once a week, but this may be increased up to 400 mg/day based on the severity of the infection and patient's response. Children and adolescents may be started at a lower dose depending on their weight and type of infection. For Sporanox, the typical initial oral dosage is 200 mg/day for adults, which can also be increased based on individual needs or specific types of fungal infections. The maximum dosage that should not be exceeded in any case is 400 mg/day for both Diflucan and Sporanox.

At what dose is Sporanox typically prescribed?

Sporanox treatment is often initiated at a dosage of 200 mg/day for fungal infections, taken once daily. If necessary, the dose can be increased to 200 mg twice per day for severe or refractory infections. For onychomycosis (fungal nail infection), the recommended dosing regimen includes two identical cycles of 200 mg twice daily for one week, with each cycle followed by a three-week period without Sporanox. The maximum dose should not exceed this recommendation and it may need adjustment if there isn't an adequate response after several weeks. As always, any changes in medication administration should only be made under doctor's supervision.

What are the most common side effects for Diflucan?

Common side effects of Diflucan and Sporanox may include the following:

  • Headache
  • Dizziness, feeling light-headed
  • Stomach pain or upset, indigestion (burning, discomfort)
  • Nausea and vomiting
  • Diarrhea or constipation
  • Changes in sense of taste
  • Rash or itching
  • Sweating excessively
    -Asthenia (general weakness or fatigue) -Unusual weight loss or weight gain -Dry mouth
    -Joint pain
    -Menstrual irregularities for women

Please note that this list is not exhaustive. If you experience any unusual symptoms after taking these medications, seek medical assistance immediately.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Diflucan?

Diflucan and Sporanox are two antifungal medications that can sometimes cause serious side effects, such as:

  • Signs of a severe skin reaction or allergy, including hives, difficulty breathing, swelling in your face or throat, fever, burning eyes, skin pain or red/purple rash with blistering and peeling
  • Vision changes: blurriness or double vision; eye discomfort; seeing halos around lights
  • Heart problems: rapid heartbeat, chest fluttering sensation/heart palpitations, shortness of breath leading to abrupt dizziness (as if you might faint)
  • Electrolyte imbalance - symptoms may include headache confusion slurred speech severe weakness vomiting loss of coordination feeling unsteady
  • Severe nervous system reactions: rigid muscles high temperature sweats confusion irregular heartbeats trembling feeling like they could pass out
  • Symptoms suggestive of the rare serotonin syndrome: restlessness hallucination raised body temperature excessive sweating shivering fast heart rate muscle stiffness twitching lack of coordination nausea vomiting and diarrhea.

If you experience any these symptoms while taking either Diflucan or Sporanox contact your healthcare provider immediately.

What are the most common side effects for Sporanox?

When taking Sporanox, some patients may experience:

  • Upset stomach or nausea
  • Vomiting and diarrhea
  • Rash or itching
  • Fatigue and dizziness
  • Headache
  • Swelling in the hands or feet
  • Unusual weight gain It's also important to note that this medication can cause more severe but rare side effects such as congestive heart failure. If you notice rapid weight gain, swelling of extremities, shortness of breath, irregular heartbeat, or persistent fatigue while on Sporanox, contact your doctor immediately.

Are there any potential serious side effects for Sporanox?

While Sporanox is generally well-tolerated, there are potential side effects that need to be closely monitored:

  • Symptoms of an allergic reaction such as skin rash, itching or hives; swelling of the face, lips or tongue which may lead to difficulty swallowing or breathing
  • Signs of liver problems including nausea, vomiting, loss of appetite, feeling generally unwell, fever, itching, yellowing of the skin and eyes and dark coloured urine
  • Numbness in the hands or feet
  • Visual disturbances such as blurred vision
  • Hearing loss or ringing in your ears (tinnitus)
  • Rapid heartbeat (tachycardia) Signs indicating changes in your nervous system function like dizziness, confusion

If you experience any severe symptoms while taking Sporanox it's critical to seek medical attention immediately.

Contraindications for Diflucan and Sporanox?

Both Diflucan and Sporanox, like most antifungal medications, may cause unwanted side effects in some people. If you notice any signs of liver damage such as persistent nausea/vomiting, severe stomach/abdominal pain or yellowing eyes/skin after taking these drugs, please seek immediate medical attention.

Neither Diflucan nor Sporanox should be taken if you are using certain types of medication including statin drugs for cholesterol (such as lovastatin), ergot alkaloids or certain benzodiazepines (like triazolam). Always tell your physician which medications you are taking; these medicines will need to be discontinued with appropriate washout periods to prevent dangerous interactions with Diflucan and Sporanox.

Additionally, both drugs can have serious cardiac side effects. Therefore, patients with a history of heart conditions must inform their healthcare provider before starting treatment with either drug.

How much do Diflucan and Sporanox cost?

For the brand name versions of these drugs:

  • The price of 14 capsules of Sporanox (100 mg) averages around $215, which works out to approximately $15.35/day if taken twice daily.
  • The price for a single oral tablet or capsule of Diflucan (150 mg) is about $30.

Thus, on a per-day treatment basis, Diflucan might be less expensive depending on the dosage and frequency prescribed by your doctor. Please note that cost should not be the primary consideration in determining which of these antifungal medications is right for you.

For the generic versions:

  • Itraconazole (generic version of Sporanox), available in packs starting from 14 up to 90 capsules (100 mg each), can cost between $1 and $7 per day depending on dose and quantity purchased.
  • Fluconazole (generic version of Diflucan) costs significantly less at around $10 for four tablets/capsules. If you're taking it just once weekly as some common dosing regimens suggest, this could work out to roughly $2.50/week or about $0.36/day.

Popularity of Diflucan and Sporanox

Fluconazole, often known by the brand name Diflucan, and itraconazole, frequently referred to as Sporanox, are antifungal medications used to treat a variety of fungal infections.

In 2020 in the United States, about 6 million people were prescribed fluconazole making it one of the most commonly prescribed antifungal medication. This represents roughly about 15% of all systemic antifungal prescriptions within that year.

On the other hand, itraconazole was given to approximately 1.8 million individuals in America during the same year. This accounts for just under 5% of total systemic antifungal prescriptions.

The popularity of fluconazole can be attributed to its wide spectrum activity against many yeasts and fungi along with better tolerability compared to older generation azole drugs like ketoconazole. However both these medicines have been around for almost similar time periods and their usage has remained stable over past decade.


Both Diflucan (fluconazole) and Sporanox (itraconazole) have established records of use in treating fungal infections, with numerous clinical studies backing their efficacy over placebo treatments. In some instances, these medications may be combined, but this requires careful consideration by a physician due to potential drug interactions. Their different mechanisms of action mean they are often prescribed under varying circumstances: fluconazole primarily inhibits the enzyme cytochrome P450 14α-demethylase, preventing the conversion of lanosterol to ergosterol required for fungal cell membrane synthesis; itraconazole also targets the same pathway but is more broadly-spectrum.

Diflucan is often considered a first-line treatment option for candidiasis and cryptococcal meningitis while Sporanox would usually be used for aspergillosis or blastomycosis or in patients who didn’t respond well to other azole antifungals.

Both drugs are available in generic form which represents significant cost savings especially for patients paying out-of-pocket. Both Diflucan and Sporanox may require an adjustment period meaning that effects may not be noticeable right away.

The side effect profiles of both drugs are similar, generally being well-tolerated although gastrointestinal upset can occur with both. However, Sporanox has been associated with congestive heart failure so needs careful monitoring in at-risk populations. Patients must closely monitor their symptoms when starting treatment and should seek medical help immediately if they notice worsening infection signs or new symptoms such as shortness of breath or swelling.