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Formulation
Capsules: 50mg, 150mg, 200mg
Suspension: 50mg/5ml, 200mg/5ml
Injection: 2mg/ml (25ml, 100ml)
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Dose
Candida treatment:
Oropharyngeal candidiasis: 50-100mg orallt once a day for 7-14 days. Up to 200mg orally once a day can be given to patients with severe oral candida
Oesophageal candidiasis 50–100mg orally once a day for 14–21 days.
In severe disease, dose up to 400mg daily
Cryptococcal meningitis:
Second-line initial therapy (when intolerant of amphotericin or mild infection)
400 mg orally/IV twice a day for up to 10 weeks (dose adjusted according to clinical / mycological response)
Consolidation therapy (CNS/lung/disseminated): 400 mg orally daily 2 weeks after induction therapy and may be reduced to 200 mg daily after 10 weeks
Therapy may be discontinued following immune restoration with cART
Cryptococcal pneumonia:
400 mg once a day for 10 weeks then 200 mg as maintenance dose
Histoplasma capsulate:
Fluconazole 800 mg orally once a day for up to 12 months. Less effective than other second-line treatment with itraconazole
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Side Effects
Gastrointestinal disturbances (nausea, diarrhoea, abdominal discomfort, flatulence); headache; rash
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Interactions
Fluconazole is metabolized by cytochrome P450 isoenzymes (although less so than other ‘azoles’)
Caution:
Concomitant use of nevirapine has been shown to result in an increased exposure of nevirapine by 100% and potentially greater risk of hepatotoxicity
Zidovudine levels may also be increased with fluconazole
Increased risk of uveitis with rifabutin
Rifampicin may decrease efficacy of fluconazole (to a lesser extent than with other ‘azoles’)
Warfarin effect enhanced
Plasma concentrations of sulphonylureas increased by fluconazole
Phenytoin effect enhanced by fluconazole
Terfenadine and astemizole contraindicated due to risk of arrhythmias
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Renal
GFR 11–50: Day 1: dose as normal followed by 50% of normal dose
Alternative dosing (Renal Handbook)
GFR 10-50: Dose as in normal renal function
GFR <10: 50% of normal dose
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Hepatic
Monitor and use with caution in patients with hepatic dysfunction
No dosage recommendations are available
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Pregnancy
Human Data Suggest Risk (>400mg/day)
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Other Information
Drug Characteristics