Known brand names include Diflucan.
An antifungal tablet or liquid for yeast infections of the vagina, mouth, throat, and esophagus, and for cryptococcal meningitis, a fungal infection around the brain and spinal cord. It interacts with many other drugs and can rarely cause liver injury or a dangerous heart rhythm.
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Fluconazole and other antifungals are not on the ISMP acute care high-alert list.
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The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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No specific antidote. Overdose has caused hallucinations and paranoid behavior; give symptomatic and supportive care, with gastric lavage if indicated. A 3-hour hemodialysis session lowers plasma levels by about 50%.
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Doses come from the FDA label. Study tool, not for clinical decisions.
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No change for single-dose vaginal candidiasis therapy. For multiple doses, give a 50 to 400 mg loading dose, then 100% of the usual dose if creatinine clearance is above 50 mL/min and 50% if 50 or less without dialysis. On hemodialysis, give 100% of the dose after each session.
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No dose table. Use with caution in liver dysfunction; serious and sometimes fatal hepatotoxicity has occurred, mostly in patients with serious underlying illness.
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A triazole antifungal that selectively inhibits fungal cytochrome P450-dependent lanosterol 14-alpha-demethylase, blocking conversion of lanosterol to ergosterol; the resulting loss of normal sterols and buildup of 14-alpha-methyl sterols is fungistatic. Oral bioavailability is over 90%, peak levels occur in 1 to 2 hours, and the half-life is about 30 hours (20 to 50). About 80% of a dose is excreted unchanged in urine, and CSF levels reach about 80% of plasma in fungal meningitis. It is a moderate CYP2C9 and CYP3A4 inhibitor and a strong CYP2C19 inhibitor, and inhibition persists 4 to 5 days after stopping.