Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Fluconazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Renal

CrCl Less Than 10 mL/min25% of dose q24h

CrCl 10-49 mL/min50% of dose q24h

CrCl Greater Than 50 mL/min100-400 mg q24h

Adult

Loading dose for Candidemia
800 mg IV/PO

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

Other indications
100-400 mg IV/PO daily

General Information

Common Usage

Common Usage

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

Cryptococcus and Coccidioides infections.

Antifungal prophylaxis in immunocompromised.

Drug Monitoring

Drug Monitoring

Consider QTc monitoring if concomitant drugs affecting the interval or elevated baseline measurement.

Adverse Effects

Adverse Effects

  • Drug interactions

  • QTc prolongation

  • Hepatic enzyme abnormalities

  • Rash

  • Alopecia

  • GI upset

Major Interactions

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.

Pharmacology

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