Fluconazole

C. diff Risk

Low

Oral Bioavailability

Excellent (90 to 100%)

Approximate Cost

$0.60 (PO)
$19.50 (IV)

Spectrum Of Activity

Dosing

Loading dose for Candidemia
800mg IV

Serious Infections
(e.g. Candidemia, CNS/Endophthalmitis)
400-800mg IV daily

Other indications
100-400mg IV/PO daily

Oral absorption is excellent; PO and IV dosing considered equivalent

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

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.

Tablet/Capsule Strengths

OPEN BENEFIT (PO)

50 and 100 mg tablets - no prescribing restrictions

150 mg single dose formulation for vaginal candidiasis not covered

Additional Information

IV Administration

  • Premixed bags of 200 and 400 mg; infuse over 1 hr (200 mg) or 2 hrs (400 mg)

  • Premixed bags are not compatible with pumps used in Community IV program

EH Prescribing Restrictions
None

Community IV Formulary (Metro Area)
NO

Tablets may be crushed for NG administration; Liquid formulation also available

Pharmacology

Antimicrobial class: Triazole antifungal

Pregnancy category: C

Average serum half life: 20 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Therapeutic

Biliary penetration: Therapeutic