Fluconazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

Dosing

Loading dose for Candidemia: 800mg IV Serious infections (Candidemia, CNS/Endophthalmitis): 400-800mg IV daily Other indications: 100-400mg IV/PO daily

General Information

Common Usage

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

Cryptococcus and Coccidioides infections

Antifungal prophylaxis in immunocompromised

Drug Monitoring

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

Adverse Effects

  • Drug interactions

  •  QTc prolongation

  •  Hepatic enzyme abnormalities

  •  Rash

  •  Alopecia

  • GI upset

  • Check LFTs within a week of starting treatment

Major Interactions

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

Pharmacology

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