Fluconazole

Generic Name Fluconazole

Brand Name (Apo-Fluconazole ,
Diflucan,
Novo-Fluconazole )

Classification PHARMACOTHERAPEUTIC: Syntheticazole.

CLINICAL: Systemic antifungal.
General Action Interferes with cytochrome P-450 activity, an enzyme necessary
for ergosterol formation.
Therapeutic Effect: Directly damages fungal membrane,
altering its function. Fungistatic.
Pharmocokinetics Well absorbed from GI tract. Widely distributed, including to
CSF. Protein binding: 11%. Partially metabolized in liver.
Excreted unchanged primarily in urine. Partially removed by
hemodialysis.
Halflife: 20–30 hrs (increased in renal impairment).
Interactions DRUG: High fluconazole dosages increase cyclosporine,
sirolimus, tacrolimus concentrations. Isoniazid, rifampin may
increase drug metabolism. May increase concentration/effects of
oral antidiabetic medication. May decrease metabolism of
phenytoin, warfarin.
HERBAL: None significant.
FOOD: None known.
LAB VALUES: May increase serum alkaline phosphatase,
bilirubin, ALT, AST.
Indications/Routes/Dosage PO and IV therapy equally
effective; IV therapy for pt intolerant of
drug or unable to take orally. Oral suspension
stable for 14 days at room temperature
or refrigerated.
Usual Dosage
PO/IV: ADULTS, ELDERLY: 150 mg once
or loading dose: 200–800 mg.
Maintenance
dose: 200–800 mg once daily.
CHILDREN AND NEONATES: Loading
dose: 6–12 mg/kg.
Maintenance dose:
3–12 mg/kg once daily.
Maximum:
 600 mg/day.
Dosage in Renal Impairment
After a loading dose of 400 mg, daily
dosage is based on creatinine clearance.
Creatinine
Clearance Dosage
Greater than
50 ml/min
100%
50 ml/min or less 50%
Dialysis 50%
CCRT 400–800 mg as
loading dose
CVVH then 200–800 mg/
day
CVVHDF 400–800 mg as
loading dose,
then 400–800 mg/
day
Dosage in Hepatic Impairment
No dose adjustment.

Availability (Rx) Injection, Solution, Pre-Mix: 200 mg (100

ml); 400 mg (200 ml). Powder for
Oral Suspension: 10 mg/ml, 40 mg/ml.
Tablets: 50 mg, 100 mg, 150 mg, 200 mg.
Lifespan Consideration Pregnancy/Lactation: Unknown if
distributed in breast milk. Pregnancy
Category C. Children: No age-related
precautions noted. Elderly: Age-related renal impairment may
require dosage
adjustment.
Side effects Occasional (4%–1%): Hypersensitivity reaction
(chills, fever, pruritus, rash), dizziness,
drowsiness, headache, constipation, diarrhea,
nausea, vomiting, abdominal pain.
Adverse Effects/Toxic Exfoliative skin disorders, serious hepatic
Reactions effects, blood dyscrasias (eosinophilia,
thrombocytopenia, anemia, leukopenia)
have been reported rarely.
Precautions Contraindications: Concomitant administration
of QT-prolonging medications.
╇ Cautions: Hepatic/renal impairment,
hypersensitivity to other triazoles
 (e.g., itraconazole, terconazole), imidazoles
(e.g., butoconazole, ketoconazole).
Nursing Considerarions BASELINE ASSESSMENT
Assess infected area. Establish baselines for
CBC, serum potassium, hepatic function.
INTERVENTION/EVALUATION
Assess for hypersensitivity reaction
(chills, fever). Monitor CBC, BMP, LFT.
Report rash, itching promptly. Monitor
temperature at least daily. Monitor daily
pattern of bowel activity, stool consistency.
Assess for dizziness; provide assistance
as needed.
PATIENT/FAMILY TEACHING
• Avoid tasks that require alertness, motor
skills until response to drug is established.
Report dark urine, pale stool,
jaundiced skin or sclera of eyes, rash,
pruritus Pts with oropharyngeal infections
should maintain fastidious oral
hygiene.Consult physician before
taking any other medication.

Source: Saunders Nursing Drug Handbook 2016