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.

Coverage

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