Oropharyngeal, esophageal, systemic candidiasis. Bone marrow transplant prophylaxis. Cryptococcal meningitis. Candida urinary tract infection (UTI), peritonitis.
Individualize. CrCl<50mL/min: reduce dose, see literature. All doses are once daily. Oropharyngeal candidiasis: 200mg on day 1, then 100mg/day for at least 2 wks. Esophageal candidiasis: 200mg on day 1, then 100mg/day for at least 3 wks; treat for at least 2 wks after symptoms resolve; max 400mg/day. Systemic candidiasis: doses of up to 400mg/day have been used. Prophylaxis of candidiasis in bone marrow transplantation: 400mg/day. Cryptococcal meningitis: 400mg on day 1, then 200–400mg/day for 10–12 wks after spinal fluid negative; to suppress relapse in AIDS: 200mg/day. UTI, peritonitis: 50–200mg/day have been used. Renal impairment: see literature.
Individualize. CrCl<50mL/min: reduce dose, see literature. All doses are once daily. Neonates: see literature. Over 2 wks of age: Oropharyngeal candidiasis: 6mg/kg on day 1, then 3mg/kg/day for at least 2 wks. Esophageal candidiasis: 6mg/kg on day 1, then 3mg/kg/day for at least 3 wks; treat for at least 2 wks after symptoms resolve; max 12mg/kg/day. Systemic candidiasis: 6–12mg/kg/day have been used. Cryptococcal meningitis: 12mg/kg on day 1, then 6mg/kg/day for 10–12 wks after negative CSF cultures; max 12mg/kg/day; to suppress relapse in AIDS: 6mg/kg/day. Max for all: 600mg/day. Renal impairment: see literature.
Concomitant pimozide, quinidine.
Proarrhythmic conditions. Renal or hepatic impairment. Monitor liver function during therapy and for signs/symptoms of hepatic injury; discontinue if develop. Monitor closely for skin rashes; discontinue if lesions progress. Elderly. Pregnancy (Cat.D); may cause rare congenital anomalies in infants exposed in-utero to high doses (400–800mg/day) during 1st trimester. Nursing mothers: not recommended.
See Contraindications. Risk of cardiotoxicity with erythromycin; avoid. Concomitant voriconazole: not recommended; if needed, monitor closely esp. when given within 24hrs after fluconazole. Potentiates warfarin, theophylline, oral hypoglycemics, midazolam. May increase serum levels of phenytoin, cyclosporine, zidovudine, sulfonylureas, carbamazepine. Thiazides increase fluconazole levels. Monitor levels and/or effects of cyclosporine, phenytoin, sulfonylureas, rifabutin, tacrolimus, theophylline, warfarin. Cimetidine (oral), rifampin may decrease fluconazole levels. Oral contraceptives: see literature. Avoid other hepatotoxic drugs. Caution with other drugs metabolized by CYP450.
Nausea, headache, rash, vomiting, abdominal pain, diarrhea; hepatotoxicity, exfoliative dermatitis (rare).
Tabs—30; Susp (35mL)—1; IV (200mg, 400mg)—6