Low
Excellent
Severe impairment (Child-Pugh C)
Should only be used if benefit outweighs risk
Mild to moderate (Child-Pugh A/B)
Standard loading dose then reduce maintenance by 50%
PO - 400mg PO q12h x 2 doses then 200mg PO q12h
IV - 6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h
Dose reduction may be required if low body weight
Requires approval by Infectious Diseases
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).
QTc interval in patients at elevated risk.
Monitor hepatic profile.
Drug interactions
QTc prolongation
Hepatic enzyme abnormalities
Rash - up to 20%
Visual disturbance
Fluorosis
GI upset
CYP450 interactions ++.
Other QTc prolonging agents.
Recommend review of pt medications due to high frequency of significant interactions.
Antimicrobial class: Triazole antifungal, Second generation
Pregnancy category: D
CSF penetration: Therapeutic
Lung penetration: Therapeutic
Urine penetration: Poor
