Antimicrobials

Active against:

• Candida species: C. albicans, C. glabrata (dose-dependent sensitivity), C. parapsilosis (may demonstrate dose-dependent susceptibility), C. tropicalis, C. dubliniensis, C. guilliermondii
• Cryptococcus species
• Dimorphic Fungi (Blastomyces, Coccidiodes)

Not active against:

• Candida krusei (intrinsic resistance)
• Aspergillus species
• Zygomycetes

• Treatment of systemic candidiasis (where fluconazole-susceptible)
• Treatment of severe mucocutaneous candidiasis
• Treatment of blastomycosis, coccidiodomycosis or cryptococcal fungal infections (consult Infectious Diseases)

• Dose reductions are required in severe renal insufficiency (see Dosing Guidelines)
• Fluconazole can inhibit the hepatic metabolism of many other drugs via CYP 450 enzymes: screen for drug interactions
• Pregnancy and breastfeeding - for safety information, see Table on Safety of Anti-infective therapy in Pregnancy & Lactation

• Nausea, vomiting, diarrhea, abdominal pain
• Elevation of transaminases; hepatotoxicity is rare.
• QT prolongation (increased risk with concomitant use of other QT-prolonging agents)
• Alopecia with doses ≥ 400mg daily after median of 3 months treatment

• Empiric therapy (Candidemia): 800 mg PO Q24H until species confirmed:
  • C. albicans, C. tropicalis, C. dubliniensis: 400 mg PO Q24H
  • C. glabrata & C. parapsilosis*: 800 mg PO Q24H

*for C. parapsilosis: may decrease dose to 400 mg PO Q24H if full sensitivity to fluconazole is confirmed. Maintain dose of 800 mg PO Q24H if fluconazole susceptibility is dose-dependent

• Esophageal candidiasis: 200 – 400 mg PO Q24H
• Vaginal candidiasis: 150 mg PO x 1 dose

Renal insufficiency:

• Baseline LFTs, QTc, serum creatinine (for dosing considerations)
• Periodic LFT assessment, QTc and serum creatinine (for dosing considerations) throughout therapy