Fluconazole is approved by the FDA for cryptococcal meningitis and various forms of candidiasis. Comparisons with amphotericin B in patients are still inconclusive. With seriously ill patients, amphotericin B remains the treatment of choice.
1. Candidiasis of the esophagus and oropharangeal membranes unresponsive to nystatin or ketoconazole.
2. Candida infection of urinary tract.
3. Cryptococcal meningitis — specimens for fungal culture and antigen detection must be obtained prior to therapy. Therapy may begin prior to results.
4. Prophylaxis to prevent relapse of cryptococcal meningitis in AIDS patients.
5. All other use must be initiated by Infectious Disease consult.
Dose: (Oral and intravenous doses of fluconazole are the same.)
Candidiasis of the mucous membranes — 200 mg x 1; then 100 mg daily for 2 weeks following resolution of symptoms.
Systemic candidiasis — 400 mg x 1; then 200 mg daily; minimum of 4 weeks therapy with 2 weeks following after CSF is culture negative.
Cryptococcal meningitis — 400 mg x 1; 200 mg daily (rarely 400 mg daily) for 10-12 weeks after CSF is culture negative.
Prophylaxis of relapse of cryptococcal meningitis in AIDS patients — 200 mg daily.
Fluconazole is excreted renally and the dose must be adjusted in impaired renal function.
Only use intravenous administration if the patient is unable to receive oral medication. Do not use intravenous administration greater than 14 days. Administration rate no greater than 200 mg/hour.
Monitor:
Potential hepatic injury
Severe skin rash in immunocompromised patients
Drug Interactions
Warfarin — increased prothrombin time
Phenytoin — increased phenytoin levels
Cyclosporin — increased cyclosporin levels
Sulfonylureas — slow metabolism, decreased blood glucose
Rifampin — increases fluconazole metabolism
