Fluconazole

제한된
0
C. difficile 위험도
Low
경구생체이용률
Excellent

Dosing

Vaginal candidiasisOropharyngeal candidiasisEsophageal candidiasisCandida UTI or peritonitisSystemic candida infection (candidemia, disseminated candidiasis, pneumonia)Cryptococcal meningitisCryptococcal meningitis relapse suppressionCandidiasis prophylaxis in HSCT patients150 mg PO 1 dose200 mg PO 1 dose, then 100 mg PO q24h x≥2w200 mg PO 1 dose, then 100 mg PO q24h x≥3w50-200 mg IV/PO q24h 400 mg IV/PO q24h400 mg IV/PO 1 dose, then 200 mg IV/PO q24h200 mg PO q24h 400 mg PO q24h

Oropharyngeal candidiasisEsophageal candidiasisSystemic candida infection(candidemia, disseminated candidiasis, pneumonia)6 mg/kg PO 1 dose, then 3 mg/kg PO q24h x≥2w6 mg/kg PO 1 dose, then 3 mg/kg PO q24h x≥3w12 mg/kg IV/PO q24h (max 600 mg/dose)

No dose adjustment

CrCl >50CrCl ≤50HDCRRTRecommended dose IV/PO q24h50% recommended dose IV/PO q24h100-400 mg q24h (give dialysis day dose AD)

Give initial loading dose of 50-400 mg, followed by the usual dose AD on HD days and 50% of the usual dose on non-HD days if CrCl ≤50200-400 mg q24h

General Information

Candida infections that are 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.

Monitor renal function, abnormal liver function, rash progression.

Common

  • Nausea

  • Vomiting

  • Headache

Serious

  • Prolonged QT interval

  • Torsades de pointes

  • Stevens-Johnson syndrome

  • Toxic epidermal necrolysis

  • Agranulocytosis

  • Anaphylaxis

  • Seizure

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.

Multiple drug-drug interactions

Antimicrobial class: Antifungal, Triazole

Pregnancy category: C

Average serum half life: 20-50 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Therapeutic

Biliary penetration: Therapeutic

Precautions:

  • Caution advised with use in patients with potentially proarrhythmic conditions.

  • Monitoring recommended in patients with liver dysfunction and discontinue if signs of liver disease develop.

  • Use caution in patients with hypersensitivity to other azole antifungal agents; cross-hypersensitivity not yet determined.

Micromedex web. Greenwood Village (CO): Truven Health Analytics; 2019 [cited 2019 October 15]. Available from: Micromedex

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