FLUCONAZOLE

Triazole broad-spectrum antifungal medicine

Dosage Forms

Capsule

50 mg
200 mg

Uses

  • Cryptococcal meningitis
  • Fungal skin infections
  • Fungal nail infections
  • Candidiasis
  • Candiduria

Dose and Duration

Vaginal candidiasis
Adult and child over 16 years: 150 mg as a single dose
Oropharyngeal and oesophageal candidiasis
Adult: 200–400 mg on day 1, then 100–200 mg once daily for 7–21 days
Neonate and child 1 month–12 years: 3–6 mg/kg on the 1ˢᵗ day then 3 mg/kg (max 100 mg) once daily (once every 48 hours in neonate 2–4 weeks and once every 72 hours in neonate under 2 weeks)
Treat for 7–14 days in oropharyngeal candidiasis (longer in immunocompromised patients) and 14–30 days in other mucosal infections
Candiduria
Adult: 200 –400 mg once daily for 7–21 days or longer in immunocompromised patients
Chronic atrophic candidiasis, chronic mucocutaneous candidiasis
Adult and child over 12 years: 50 mg once daily (100 mg in difficult infections) once daily 14–28 days or longer depending on response
Invasive candidal infections and cryptococcal infections
Adult: 400 mg on the 1ˢᵗ day, then 200–400 mg once daily (max 800 mg once daily in severe life-threatening infections) for 6–8 weeks or according to response
Neonate and child 1 month–18 years: 6–12 mg/kg (max 800 mg) once daily (once every 48 hours in neonate 2–4 weeks and once every 72 hours in neonate under 2 weeks) for 6–8 weeks according to response
Tinea pedis, corporis, cruris, pityriasis versicolor and dermal candidiasis
Adult: 50 mg once daily for 2–4 weeks (max 6 weeks in tinea pedis)
Child 1 month–18 years: 3 mg/kg (max 50 mg) once daily for 2–4 weeks (6 weeks in Tinea pedis). Maximum duration 6 weeks
Tinea capitis
Child 1 month–18 years: 6 mg/kg(max 300 mg) once daily for 2–4 weeks
Prophylaxis of recurrent vaginal candidiasis
Adult: 150 mg once weekly for 6 months
Prophylaxis of cryptococcal meningitis in HIV patients
Adult: 200 mg once daily indefinitely
Child 1 month–18 years: 6 mg/kg (max 200 mg) once daily
Prophylaxis of other fungal infections in immunocompromised patients
Adult: 50–400 mg once daily adjusted according to risk (max 400 mg once daily in high risk infections)
Neonate and child 1 month–18 years: 3–12 mg/kg (max 400 mg) once daily (max 12 mg/kg (400 mg) in high risk infections). Give once every 2 days in neonate 2–4 weeks and once every 72 hours in neonate under 2 weeks

Contraindications

  • Acute porphyria
  • Co-administration with terfenadine in patients receiving fluconazole doses of 400 mg daily
  • Hypersensitivity to fluconazole or other azoles

Side Effects

  • Nausea, abdominal and gastrointestinal pain, diarrhoea, vomiting, flatulence
  • Headache
  • Increased liver enzyme levels, hepatic failure
  • Torsades de pointes
  • Rash, Stevens-Johnson syndrome

Interactions

  • Artemether + lumefantrine (manufactures advises avoid)
  • Ciclosporin (increased concentration of ciclosporin)
  • Clopidogrel (possibly reduced antiplatelet effect)
  • Diazepam, midazolam (increased plasma concentration of diazepam and midazolam-risk of prolonged sedation)
  • Glibenclamide (increased concentration of glibenclamide)
  • Nevirapine (increased plasma concentration of NVP)
  • Phenytoin (plasma concentration of phenytoin increased)
  • Rifampicin (reduced plasma concentration of fluconazole)
  • Tacrolimus (increased concentration of tacrolimus)
  • Warfarin (enhanced anticoagulant effect of warfarin)
  • Zidovudine (increased risk of zidovudine toxicity)

Pregnancy

  • Do not use

Breast-feeding

  • Can be used

⚠️ Caution

  • In mild to moderate renal impairment, initiate with the usual dose then halve subsequent doses
  • Use with caution in concomitant use with hepatotoxic medicines. Monitor liver function in high doses or extended courses. Discontinue if signs of liver damage occur