Drug Characteristics
  • Formulation

    Capsules: 50mg, 150mg, 200mg

    Suspension: 50mg/5ml, 200mg/5ml

    Injection: 2mg/ml (25ml, 100ml)

  • 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

  • Side Effects

    Gastrointestinal disturbances (nausea, diarrhoea, abdominal discomfort, flatulence); headache; rash

  • 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        

  • 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

  • Hepatic

    Monitor and use with caution in patients with hepatic dysfunction

    No dosage recommendations are available        

  • Pregnancy

    Human Data Suggest Risk (>400mg/day)

  • Other Information