See drug monitoring information IV - 6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h PO - 400mg PO q12h x 2 doses then 200mg PO q12h Dose reduction may be required if low body weight
Severe impairment (Child-Pugh C)- Should only be used if benefit outweighs risk Mild to moderate (Child-Pugh A/B) - Standard loading dose then reduce maintenance by 50%
0 - 50 50+ 6mg/kg IV load and then STOP IV formulation Continue course with 200mg PO q12hIV - 6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h PO - 400mg PO q12h x 2 doses then 200mg PO q12h Dose reduction may be required if low body weight
IV therapy not recommended after first loading dose due to accumulation of cyclodextrin Oral dosing does not require modification in renal failure
6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h
Candida infections both mucocutaneous and invasive - i.e. Candidemia
Antifungal prophylaxis in immunocompromised
Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity (discuss with ID)
QTc interval in patients at elevated risk
Monitor hepatic profile
Drug interactions
QTc prolongation
Hepatic enzyme abnormalities
Rash - up to 20%
Visual disturbance
Fluorosis
GI upset
CYP450 interactions ++
Other QTc prolonging agents
Recommend review of pt medications due to high frequency of significant interactions
Antimicrobial class: Triazole antifungal, second generation
Pregnancy category: D
CSF penetration: Therapeutic
Lung penetration: Therapeutic
Urine penetration: Poor
