Antimicrobials
Fluconazole

Fluconazole

C difficile risk
Low
Oral Bioavailability
Excellent
Cost
IV-$15/d PO-$3/d

Dosing

Loading dose for Candidemia: 800mg IV

Serious infections i.e. Candidemia, CNS/Endophthalmitis: 400-800mg IV daily

Other indications: 100-400mg IV/PO daily

0 - 50 eGFR50+ eGFR200mg IV/PO q24h400mg IV/PO q24h

Give full dose by indication after each HD session

400mg IV q12h 400mg PO q12h

General Information

Candida infections both mucocutaneous and invasive - i.e. Candidemia

Cryptococcus and Coccidioides infections

Antifungal prophylaxis in immunocompromised

Consider QTc monitoring if concomitant drugs affecting the interval or elevated baseline measurement

  • Drug interactions

  • QTc prolongation

  • Hepatic enzyme abnormalities

  • Rash

  • Alopecia

  • GI upset

Many via CYP450 - suggest review specific patient medications

Fluconazole increases levels of phenytoin, cyclosporine, tacrolimus, warfarin, oral hypoglycemics

Risk when combining with other QTc prolonging medications

Antimicrobial class: Triazole antifungal, decreases ergosterol synthesis

Pregnancy category: C

Average serum half life: 20.0

Biliary penetration: Therapeutic

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic