6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h
400mg PO q12h x 2 doses then 200mg PO q12h
Dose reduction may be required if low body weight (i.e. less than 40 kg = 100 mg PO BID)
Mild to moderate (Child-Pugh A/B)Standard loading dose then reduce maintenance by 50%
Severe impairment (Child-Pugh C)Should only be used if benefit outweighs risk
Candida infections both mucocutaneous and invasive - i.e. Candidemia.
Antifungal prophylaxis in immunocompromised patients.
Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity (Discuss with ID).
Check with chemistry lab as specimen may need to be referred out of province.
QTc interval in patients at elevated risk.
Monitor hepatic profile.
Hepatic enzyme abnormalities
Rash - up to 20%
CYP450 interactions ++.
Other QTc prolonging agents.
Recommend review of pt medications due to high frequency of significant interactions.
PO: Requires special authorization
Dilute in 100 -250 mL D5W or NS and administer over 1-2 hrs.
Max concentration 5 mg/mL. Max rate 3 mg/kg/min
EH Prescribing Restrictions
Community IV Formulary (Metro)
Requires Special Authorization
Costs for PO are based on Eastern Health Contract Pricing. Costs are MARKEDLY higher in Community Setting
Antimicrobial class: Triazole antifungal, Second generation
Pregnancy category: D
CSF penetration: Therapeutic
Lung penetration: Therapeutic
Urine penetration: Poor