Fluconazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

IV:$
PO Tablets:$
PO Suspension:$$

Dosing

Adult

Loading dose for Candidemia
800mg IV

Serious infections
i.e. 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

Laboratory

  • Baseline and periodic LFTs and Cr (dose adjustment assessment)

Clinical

  • GI effects

  • Prolongation of QT interval with risk factors

  • Hypersensitivity

  • Photosensitivity

  • Drug-drug interactions

Adverse Effects

  • GI effects

  • Hepatitis

  • QT prolongation

  • Hypersensitivity

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 hours

Biliary penetration: Therapeutic

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic