Adult Dosing
Candidiasis, oropharyngeal
- 200 mg IV on day 1, then 100 mg IV q24 hrs for >2 wks
Candidiasis, esophageal
- 200 mg IV on day 1, then 100 mg IV q24 hrs for >3 wks or atleast 2 wks following resolution of symptoms
- Max: 400 mg/day
Candidiasis, systemic
Cryptococcal meningitis
- Treatment regimen: 400 mg IV on day 1, then 200-400 mg IV q24 hrs. Continue for 10-12 weeks after CSF culture is negative
- Suppression regimen (patients with HIV): 200 mg IV q24 hrs
Fungal Prophylaxis, bone marrow transplant
- 400 mg IV q24 hrs
- Begin several days before anticipated onset of neutropenia, continue for 7 days after neutrophil count >1000 cells/mm3
Pediatric Dosing
Candidiasis, oropharyngeal
- 6 mg/kg IV on day 1, followed by 3 mg/kg IV q24 hrs for >2 wks
- Max: 100 mg/day
Candidiasis, esophageal
- 6 mg/kg IV on day 1, followed by 3 mg/kg IV q24 hrs for >3 wks and for >2 wks following resolution of symptoms
- Max: 400 mg/day
Candidiasis, systemic
Cryptococcal meningitits
- Treatment regimen: 12 mg/kg on day 1, then 6 mg/kg q24 hrs. Continue for 10-12 weeks after CSF culture is negative
- Suppression regimen (patients with HIV): 6 mg/kg IV q24 hrs
Fungal Prophylaxis; bone marrow transplant
- 10-12 mg/kg IV q24 hrs
- Begin several days before anticipated onset of neutropenia, continue for 7 days after neutrophil count >1000 cells/mm3
[Outline]
Renal Dose Adjustment (Based on CrCl)
- >50 mL/min: No dose adjustments
50 mL/min: Give usual loading dose; reduce subsequent doses by 50%- Hemodialysis: Give usual dose after each session
Hepatic dose adjustment
- Hepatic impairment: Use with caution; dose adjustments not defined
- Some azoles, including fluconazole, have been associated with prolongation of the QT interval. Rare cases of QT prolongation and torsade de pointes in patients taking fluconazole have been reported in post-marketing surveillance
- Fluconazole has been associated with rare cases of serious hepatic toxicity, including fatalities primarily in patients with serious underlying medical conditions. Patients with hx of cardiotoxic chemotherapy, cardiomyopathy, hypokalemia and concomitant medications that increase QT interval are at an increased risk
- Anaphylaxis has occurred rarely with fluconazole therapy
- Exfoliative skin disorders have also been reported; monitor closely if rash develops and discontinue if it progresses
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Hepatic impairment (refer dose adjustment section)
- Hx of cardiac disease
- Electrolyte abnormalities
- Geriatric population
- Hx of arrhythmia
- Drugs metabolized by CYP450. Potent 3A4 Inhibitors. Caution and possible contraindications including astemizole, ergot derivatives, methlysergide, terfenadine, thioridazine, short acting benzodiazepines
Pregnancy Category:D
Breastfeeding: Fluconazole is excreted in breastmilk; levels in breastmilk are less than those given to infants. This drug is considered acceptable with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 ) and based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 19 July 2010). According to manufacturer's data, use during breastfeeding is not recommended.
