Top 300 Pharmacy Drug Cards

FLUCONAZOLE: Diflucan, Various

Class: Imidazole Antifungal

Dosage Forms. Powder for Suspension: 10 mg/mL, 40 mg/mL; Tablet: 50 mg, 100 mg, 150 mg, 200 mg

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Common FDA Label Indication, Dosing, and Titration.

1. Candidal vulvovaginitis, uncomplicated: 150 mg po × 1

2. Candidal vulvovaginitis, complicated: 150 mg po q72h × 3 doses

3. Candidiasis: systemic: Adults, 400 mg po daily; Children (6 mo and older), 6-12 mg/kg/d po

4. Cryptococcal meningitis: Adults, 400-800 mg po daily × 8 wk, then 200 mg po daily × 6-12 mo; Children 6 mo and older, 12 mg/kg po on day 1, then 6 mg/kg/d (max 12 mg/kg/d) for 10-12 wk

5. Oropharyngeal candidiasis: Adults, 100-200 mg po daily × 7-14 d; Children 6 mo and older, 6 mg/kg po on day 1, then 3 mg/kg once daily for at least 2 wk

Off-Label Uses.

1. Onychomycosis due to dermatophyte: 200 mg po qwk × 3 mo (fingernails), × 6 mo (toenails)

2. Tinea: 200 mg po qwk × 3 doses

MOA. Fluconazole inhibits biosynthesis of ergosterol or other sterols, damaging the fungal cell wall membrane and altering its permeability.

Drug Characteristics: Fluconazole

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Medication Safety Issues: Fluconazole

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Drug Interactions: Fluconazole

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Adverse Reactions: Fluconazole

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Efficacy Monitoring Parameters. Resolution of signs and symptoms of infection.

Toxicity Monitoring Parameters. Severe skin irritation or rash, unusual bruising or bleeding, rapid heart beat, yellowing of the eyes or skin; monitor serum potassium.

Key Patient Counseling Points. Many medications, including OTC medications, interact with fluconazole. Do not take any new medications without consulting your doctor or pharmacist. If taking a weekly dose, take on same day and time each week.

Clinical Pearls. Oral and IV doses are interchangeable. Amphotericin is more effective than fluconazole in treating serious fungal infections; fluconazole is typically used as adjunctive therapy or maintenance therapy. In vaginal candidiasis, single-dose fluconazole is at least as effective as a 5-d course of oral ketoconazole or a 3-d course of intravaginal clotrimazole.