1 vial 100mg

95 cents

1 tablet 200mg

47 cents

Canesten Fluconazole, Diflucan, Flucazole

  • Candidiasis

  • Cryptococcal meningitis

  • Prophylaxis against Candida infections in patients after bone marrow transplantation

IV:
100mg in 50ml (formulated in normal saline)
Administer undiluted solution at a constant rate not exceeding 200mg/hr (eg one vial over 30 minutes or two vials over 60 minutes); dilution is not recommended.
Fluconazole may be administered through an existing line with the following IV fluids:
Hartmanns Sodium bicarbonate Sodium chloride
5% dextrose 20% dextrose 20mmol & 50mmol KCl in 5% dextrose
Discard any solution not used within 24 hours or opening
Do not use if solution is cloudy
Store at room temperature

PO:
Capsules:
Canesten Fluconazole 150mg capsules (white), Diflucan 50mg capsule (light turquoise / white), Diflucan 200mg capsules (purple / white), Diflucan One 150mg capsules (light turquoise blue), Flucazole 150mg capsules (white), Fluconazole (pacific) 50mg capsules (dark blue / white), Fluconazole (pacific) 150mg capsules (white), Fluconazole (pacific) 200mg capsules (blue / white)
Oral Suspension:
Diflucan suspension 50mg/5ml


ADULT DOSE

PO & IV:
Severe infections: - 400mg stat then 200-400mg daily
Mild infections:
- 200mg stat then 100-200mg daily
Prophylaxis – 200mg – 400mg daily (usually oral)

Note: the IV and oral dosages are the same; fluconazole is rapidly and nearly completely absorbed when administered orally (under normal circumstances)

PAEDIATRIC DOSE

PO & IV:
Severe infections: - 12mg/kg stat (max 800mg), then 6-12mg/kg daily
Mild infections: - 6mg/kg stat, then 3mg/kg daily

Note: the IV and oral dosages are the same; fluconazole is rapidly and nearly completely absorbed when administered orally (under normal circumstances)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose in renal impairment [GFR (ml/min)]
<10 50% of normal dose
10-20 dose as in normal renal function
>20-50 dose as in normal renal function

Dose in renal replacement therapy
CAPD 50% of normal dose
HD 50% of normal dose; give post dialysis
CVVHDF dose as in normal renal function

Fluconazole is a highly selective inhibitor of fungal cytochrome P-450 sterol C-14 alpha-demethylation. Mammalian cell demethylation is much less sensitive to fluconazole inhibition. The subsequent loss of normal sterols correlates with the accumulation of 14 alpha-methyl sterols in fungi and may be responsible for the fungistatic activity of fluconazole. The bioavailability of orally administered fluconazole is over 90% compared with intravenous administration.

CONTRAINDICATIONS:

  • Hypersensitivity to fluconazole


WARNINGS
Hepatic Injury:
Fluconazole has been associated with rare cases of serious hepatic toxicity, including fatalities primarily in patients with serious underlying medical conditions. In cases of fluconazole associated hepatotoxicity, no obvious relationship to total daily dose, duration of therapy, sex or age of the patient has been observed. Fluconazole hepatotoxicity has usually, but not always, been reversible on discontinuation of therapy. Patients who develop abnormal liver function tests during fluconazole therapy should be monitored for the development of more severe hepatic injury. Fluconazole should be discontinued if clinical signs and symptoms consistent with liver disease develop that may be attributable to fluconazole.
Anaphylaxis:
In rare cases, anaphylaxis has been reported.

PRECAUTIONS
General
Patients have rarely developed exfoliative skin disorders during treatment with fluconazole. Patients who develop rashes during treatment with fluconazole should be monitored closely and the drug discontinued if lesions progress.

Laboratory Tests:
No tests in addition to routine ICU tests are required.

Drug/Laboratory Test Interactions
None noted.

Clinically or potentially significant drug interactions between fluconazole and the following agents/classes have been observed. These are described in greater detail below:

Oral Hypoglycaemics:
Clinically significant hypoglycaemia may be precipitated by the use of fluconazole with oral hypoglycaemic agents: 1 fatality has been reported from hypoglycaemia in association with combined fluconazole and glyburide use. Fluconazole reduces the metabolism of tolbutamide, glyburide, and glipizide and increases the plasma concentration of these agents. When fluconazole is used concomitantly with these or other sulfonylurea oral hypoglycaemic agents, blood glucose concentrations should be carefully monitored and the dose of the sulfonylurea should be adjusted as necessary.

Warfarin:
Prothrombin time may be increased in patients receiving concomitant fluconazole and coumarin-type anticoagulants. Careful monitoring of prothrombin time in patients receiving fluconazole and coumarin-type anticoagulants is recommended.

Phenytoin:
Fluconazole increases the plasma concentrations of phenytoin. Careful monitoring of phenytoin concentrations in patients receiving fluconazole and phenytoin is recommended.

Cyclosporin:
Fluconazole may significantly increase cyclosporin levels in renal transplant patients with or without renal impairment. Careful monitoring of cyclosporin concentrations and serum creatinine is recommended in patients receiving fluconazole and cyclosporin.

Rifampin:
Rifampin enhances the metabolism of concurrently administered fluconazole. Depending on clinical circumstances, consideration should be given to increasing the dose of fluconazole when it is administered with rifampin.

Theophylline:
Fluconazole increases the serum concentrations of theophylline. Careful monitoring of serum theophylline concentrations in patients receiving fluconazole and theophylline is recommended.

Body as a whole:
anaphylaxis
Gastrointestinal:
Nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, hepatitis, cholestasis, fulminant hepatic failure
Neurological:
Seizures, headache
Haematological:
Leukopaenia, thrombocytopaenia.
Dermatological:
Skin rash, exfoliative skin disorders including Stevens-Johnson Syndrome and toxic epidermal necrolysis

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