Fluconazole

C difficile risk
Low
Oral Bioavailability
Excellent

Dosing

Loading dose for Candidemia: 800 mg IV

Serious infections (Candidemia, CNS/Endophthalmitis): 400 - 800 mg IV/PO daily

Other indications: 100 - 400 mg IV/PO daily

Loading dose: 25 mg/kg IV/PO Maintenance dose: 12 mg/kg/dose IV/PO Q24H

Age 0-14 DaysAge > 14 DaysNote:6 mg/kg/dose PO/IV Q72H6 mg/kg/day PO/IV Q48HFungal prophylaxis can be continued until patient is no longer considered high-risk for invasive candidiasis

Loading Dose: 6 mg/kg PO Maintenance dose: 3 mg/kg/dose PO Q24H x 7 days

Infuse over 2 hours

IV, PO

IV: 2 mg/mL PO: 10 mg/mL

Supplied by Manufacturer

IV: 24h Room Temperature

Infuse over 2 hours

0 - 30 eGFR30 - 50 eGFR50+ eGFR100 - 200mg IV/PO q24h (higher doses may be required for severe infections)100 - 200mg IV/PO q24h (400 mg IV/PO q24h for invasive infections)No dose adjustment required

Increase dosing interval in neonates with impaired renal function

General Information

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

  • Cryptococcus and Coccidioides infections

  • Antifungal prophylaxis in immunocompromised

Pregnancy:

  • High dose (≥ 400 mg/day):

    • May be associated with congenital malformations with first trimester use (resembling Antley Bixler syndrome)
    • May be associated with an increased risk of miscarriage
  • Low dose (150 - 300 mg/day, short course): (including those used for vaginal yeast infections)

    • Likely not associated with congenital malformations
    • May be associated with an increased risk of miscarriage
  • Does not appear to be associated with stillbirth at any dose

Recommended not to use oral fluconazole to treat vaginal yeast infections in pregnancy. First line therapy in pregnancy is 7 days topical antifungal agents (ie. clotrimazole, miconazole)

Breastfeeding:

  • Fluconazole transfers into breastmilk.

  • The relative infant dose (RID) is reported as 16-22%.

  • Based on limited data, no adverse effects have been reported in breastfeeding infants.

  • Fluconazole is used at therapeutic doses to treat invasive Candida infections in neonates.

  • Consider QTc monitoring in patients at increased risk.

  • Liver function tests, check baseline and one week after starting treatment.

  • Multiple drug interactions possible, consult pharmacy.

  • QTc prolongation

  • Hepatic enzyme abnormalities, hepatitis

  • Rash

  • Alopecia

  • GI upset

  • Multiple drug interactions possible. Inhibits CYP2C19 (strong), CYP2C9 (moderate), CYP3A4 (moderate).

  • Inhibits metabolism of phenytoin (increase phenytoin plasma levels) and careful monitoring of phenytoin serum concentrations is required.

  • Inhibits metabolism of zidovudine (ZDV). Monitor patients closely for adverse effects of ZDV.

  • Inhibits metabolism of cisapride (contraindicated in patients receiving cisapride).

Antimicrobial class: Triazole antifungal, decreases ergosterol synthesis

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