Indications
- Dermatophyte infections
- Tinea pedis (moccasin type)/tinea manuum (adults):150–450 mg/week ×4–6 weeks;(children):6 mg/kg/week × 4–6 weeks.
- Tinea unguium(adults):150–450 mg/week until nails are clear;(children): 6 mg/kg/week × 3–4 months (fingernails) or 5–7 months (toenails), or until nails are clear.
- Tinea corporis (extensive, adults):150–200 mg/week ×2–4 weeks;(extensive, children):6 mg/kg/week × 2–4 weeks.
- Tinea capitis (adults) : 6 mg/kg/day × 3–6 weeks;(children) : 6 mg/kg/day × 3–6 weeks.
- Oropharyngeal candidiasis :200 mg po on day 1, then 100–200 mg po daily for 7–14 days after clinical resolution.
- Candidal intertrigo : 150 mg po weekly for 2–4 weeks.
- Chronic mucocutaneous candidiasis : Eradication: 400–800 mg po daily for 4–6 months ; Suppressive therapy: 200 mg po daily.
- Vaginal candidiasis, oropharyngeal and esophageal candidiasis, and cryptococcal meningitis.
- Tinea versicolor : 200 mg po daily × 5–7 days;200–300 mg weekly × 2–3 weeks; or 400 mg once.
- Cutaneous candidiasis: 150 mg once weekly given for 2–4 weeks.
- Recurrent Candidiasis :150 mg weekly for 6 months.
- Sporotrichosis, cutaneous and lymphonodular.
- Leishmaniasis: 200 mg/day or 6–8 mg/kg/day PO × 6 weeks.
Dosage
- According to diagnosis, revise indications.
- Renal dosing for iv :
- Creatinine clearance (crcl) 50–90 ml/min: normal dose of 200–400 mg iv qd.
- Crcl < 50 ml/min, continuous arteriovenous hemofiltration, chronic ambulatory.
- Peritoneal dialysis: 50% of normal dose.
- Hemodialysis: extra 200 mg iv after dialysis.
Side effects
- Common (≥1% of patients): rash, headache, dizziness, nausea, vomiting, abdominal pain, diarrhea, and/or elevated liver enzymes.
- Infrequent (0.1–1% of patients): anorexia, fatigue, constipation.
- Rare (<0.1% of patients): oliguria, hypokalaemia, paraesthesia, seizures, alopecia, Stevens–Johnson syndrome, thrombocytopenia, other blood dyscrasias, serious hepatotoxicity including liver failure, anaphylactic/anaphylactoid reactions.
- Very rare: prolonged QT interval, torsades de pointes, ventricular tachycardia, cardiac arrest and sudden death have been noted.
- High doses of fluconazole during the first trimester of pregnancy may be associated with a rare and distinct set of birth defects in infants.
Contraindications
- Hypersensitivity to fluconazole.
- Impaired liver or renal function.
- Pregnancy.
Interactions
- Fluconazole is contraindicated with erythromycin,cisapride, astemizole, pimozide, and quinidine, as well as terfenadine when dosing of fluconazole is 400 mg or greater.
- Increased central nervous system depression: alfentanil, benzodiazepines, propoxyphene, buprenorphine, fentanyl.
- Increased levels of: amiodarone, almotriptan, aprepitant, aripiprazole,bosentan, budesonide, buspirone, ergotamine, carbamazepine, celecoxib, cilostazol, cyclopsorin, digoxin, eletriptan, statins, imatinib, levobupivacaine, metformin, sulfonylureas, methadone, mifepristone, modafinil, nefazodone, phenytoin, quetiapine, quinidine, repaglinide, sildenafil,sirolimus, tacrolimus, theophylline, tolterodine, vinca alkaloids, warfarin, ziprasidone, zonisamide.
- Increased levels of fluconazole: amprenavir, protease inhibitors, paclitaxel.
- Decreased levels of fluconazole: barbiturates, rifampins.
- Increased risk of hypotension: bepridil, calcium channel blockers.
- Increased Qt prolongation: cisapride, pimozide.
- Increased arrhythmias: disopyramide.
- Increased hyperglycemia: pioglitazone.
Pregnancy &Lactation
- Pregnancy category D.
- Fluconazole is secreted in human milk at concentrations similar to plasma. Therefore, the use of fluconazole in lactating mothers is not recommended.
Precautions
- Use with caution in liver dysfunction.
- May need to adjust fluconazole dosing renal dysfunction.
- Monitor patients with abnormal LFT;discontinue if signs of liver disease.
- Use with caution in proarrhythmic conditions.
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