Capsules: 50mg, 150mg, 200mg

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

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

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

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

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        

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

Monitor and use with caution in patients with hepatic dysfunction

No dosage recommendations are available        

Human Data Suggest Risk (>400mg/day)