Infectious Disease Compendium

Fluconazole (Diflucan®)

Dosing

CrCl Formula

CrCl > 80: 100 to 800 mg po or IV qd.

CrCl 80-50:

CrCl 50-10: decrease by 50%.

CrCl < 10: decrease by 25 %.

Hemodialysis:

Peritoneal dialysis:

Obesity dosing

Important side effects

Hepatitis (rare).

Important drug interactions

Acenocoumarol, alfentanil, amitriptyline, amlodipine, anisindione, antipsychotics, arsenic trioxide, astemizole, atevirdine, atorvastatin, benzodiazepines, bepridil, carbamazepine, celecoxib, cerivastatin, chaparral, chloral hydrate, chlordiazepoxide/amitriptyline, chloroquine, cimetidine, cisapride, clarithromycin, class i antiarrhythmic agents, class ia antiarrhythmic agents, class iii antiarrhythmic agents, cotrimoxazole, cyclosporine, dicumarol, dolasetron, droperidol, eletriptan, enflurane, ergot derivatives, erythromycin, erythromycin/sulfisoxazole, ethinyl estradiol, etonogestrel, felodipine, fentanyl, fluoxetine, fluvastatin, foscarnet, fosphenytoin, gemifloxacin, germander, glipizide, glyburide, halofantrine, halothane, isoflurane, isradipine, levomethadyl, levonorgestrel, lidoflazine, losartan, lovastatin, mefloquin, mesoridazine, mestranol, methadone, nevirapine, nicardipine, nifedipine, nitrofurantoin, norelgestromin, norethindrone, norgestrel, nortriptyline, octreotide, pennyroyal, pentamadine, perphenazine/amitriptyline, phenindione, phenothiazines, phenprocoumon, phenytoin, pimozide, prednisone, probucol, quetiapine, rifabutin, rifampin, rifapentine, rosuvastatin, simvastatin, spiramycin, sulfamethoxazole, tacrolimus, telithromycin, terfenadine, thioridazine, tolbutamide, tretinoin, tricyclic antidepressants, trimethoprim, trimetrexate, vasopressin, venlafaxine, warfarin, zidovudine, ziprasidone, zolmitriptan.

These drugs interact with damn near everything else so check with you pharmacist or this reference at CID.

"Oral fluconazole exposure was NOT associated with a significantly increased risk of 14 of 15 types of birth defects previously linked to azole antifungal agents: craniosynostosis, other craniofacial defects, middle-ear defects, cleft palate, cleft lip, limb defects, limb-reduction defects, polydactyly, syndactyly, diaphragmatic hernia, heart defects overall, pulmonary-artery hypoplasia, ventricular septal defects, and hypoplastic left heart. A significantly increased risk of tetralogy of Fallot was observed." (PubMed).

BUT IT MAY INCREASE THE RISK OF MISCARRIAGE AND STILLBIRTH (PubMed). Sorry I shouted, but that would seem important.

Rants and Screeds

Pearls

Treatment of choice

Use for

Candida albicans, be wary of using for other Candida. Can be used for Cryptococcus neoformans, Coccidiodes immitis. Histoplasmosis, Leishmania, ocular infections, Onycomycosis, Penicillium marneffei infection, Sporothrix.

Don't use for

C. krusei is often resistant.

Class

Imidazole.