Spectrum: Local Antimicrobial Stewardship, for Billings Clinic

Fluconazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

PO: $1-2/day
IV: $3-5/day

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Renal

Adult

Loading dose for Candidemia
800mg IV (12 mg/kg x 1)

Serious Infections
(e.g. Candidemia, CNS/Endophthalmitis)
400-800mg IV daily (6 mg/kg/day)

Other indications
100-400mg 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