Tertiary Peritonitis
Fluconazole

Fluconazole

Low
Excellent
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status Yes (PO solid, PO powder for soln, parenteral inj)

In-Hospital Cost will be updated

PharmaCare Formulary Status Yes (PO solid, PO soln)

Special Authority Yes (PO solid) (See below under Restricted Use Criteria)

PharmaCare Coverage 50mg PO - $1.3936/tab 100mg PO - $2.4722/tab 150mg PO - $3.9303/cap 10mg/ml PO susp recon - $1.2955/ml

Outpatient Cost 50mg PO - $1.46-2.07/tab 100mg PO - $2.91-10.06/tab 150mg PO - $3.64-7.69/cap 10mg/ml PO susp recon - $1.30-1.42/ml 2mg/ml soln for inj - $0.51-0.56/ml

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.

Special Authority Status: Yes (PO solid)

Special Authority Category: Limited Coverage Drugs

Special Authority Criteria:

  • immunocompromised patients OR
  • exceptions on an individual basis for fungal infections resistant to first-line medications

Special Authority Approval Period: One day to indefinite

Special Authority Practitioner Exemptions: Physicians specializing in treatment of HIV/AIDS patients

Special Authority Special Notes: None

Gastritis (PO and IV)

  • sx: nausea, abdominal pain, vomiting, and diarrhea
  • more common with itraconazole and ketoconazole

Hepatotoxicity (mainly with IV)

  • usually hepatocellular but may be cholestatic or both
  • includes mild elevations in transaminases, hepatitis, cholestasis and fulminant hepatic failure
  • hepatic inflammation may be exposure related, especially with voriconazole
  • liver enzymes normalize and sx resolve gradually over weeks after discontinuation

Alopecia (mainly with IV)

  • can occur with long courses of high-dose fluconazole
  • reversible after discontinuation

Chapped lips (mainly with IV)

  • can occur with long courses of high-dose fluconazole
  • reversible after discontinuation

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 hr

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Therapeutic

Biliary penetration: Therapeutic