Fluconazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

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

Spectrum Of Activity

Dosing

Loading dose for Candidemia
800mg IV

Serious infections
i.e. Candidemia, CNS/Endophthalmitis
400-800mg IV daily

Other indications
100-400mg IV/PO daily

Fluconazole has high oral bioavailability – consider initiating with/switching to oral therapy when patient tolerating orals

CrCl >50 mL/minCrCl 10 - 50 mL/minCrCl <10 mL/min (ESRD not on HD)Oropharyngeal Candidiasis: 100mg daily
Esophageal Candidiasis: 200mg daily
Severe Infections : 400mg daily
Other: 100 - 400 mg IV/PO Q24h50 - 200 mg IV/PO Q24h 50 -100 mg IV/PO Q24h

Dialysis (HD)Dialysis (CRRT)200 mg IV/PO daily400 – 800 mg IV/PO Q24h

Creatinine Clearance >50mL/min/1.73m²Creatinine Clearance 10-50mL/min/1.73m²Creatinine Clearance ≤10mL/min/1.73m²Loading Dose
6-12mg/kg/dose x1 dose
Maximum: 400mg/dose to 800 mg/dose

Then

Maintenance Dose
6 mg/kg/dose Q12H to Q24H
Maximum DAILY dose: 600mg3-6mg/kg/dose Q24H1.5 – 3 mg/kg/dose Q48H

Creatinine Clearance >50mL/min/1.73m²Creatinine Clearance 10-50mL/min/1.73m²Creatinine Clearance ≤10mL/min/1.73m²3-6 mg/kg/dose Q24H
Maximum dose: 200mg to 400mg3 mg/kg/dose Q24H3 mg/kg/dose Q48H

General Information

  • GI effects

  • Hepatitis

  • QT prolongation

  • Hypersensitivity

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

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

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

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

Cryptococcus and Coccidioides infections

Antifungal prophylaxis in immunocompromised