Home Drug Guide Fluconazole

Drug Guide

Generic Name

Fluconazole

Brand Names Diflucan

Classification

Therapeutic: Antifungal

Pharmacological: Azole antifungal

FDA Approved Indications

  • Candidiasis (oropharyngeal, esophageal, invasive candidiasis)
  • Cryptococcal meningitis
  • Histoplasmosis
  • Coccidioidomycosis
  • Other fungal infections

Mechanism of Action

Fluconazole inhibits fungal cytochrome P450 enzymes, decreasing ergosterol synthesis and disrupting fungal cell membrane formation.

Dosage and Administration

Adult: Typically 200-400 mg on the first day, then 100-400 mg once daily, depending on the infection.

Pediatric: Dosing varies based on weight and age; consult specific guidelines.

Geriatric: Adjustments may be necessary due to renal function; monitor renal function closely.

Renal Impairment: Reduce dosage in patients with renal impairment; no dose adjustment required if used for cryptococcal meningitis at 400 mg daily.

Hepatic Impairment: Use with caution; no specific dose adjustment necessary for mild to moderate hepatic impairment.

Pharmacokinetics

Absorption: Well absorbed orally (~90%)

Distribution: Widely distributed, including cerebrospinal fluid and ocular fluids

Metabolism: Minimal hepatic metabolism

Excretion: Primarily renal (unchanged drug); some excretion in feces

Half Life: Approximately 30 hours

Contraindications

  • Hypersensitivity to fluconazole or other azole antifungals

Precautions

  • Use with caution in hepatic or renal impairment, during pregnancy (category D), and in patients taking medications that may interact adversely

Adverse Reactions - Common

  • Headache (Occasional)
  • Nausea (Occasional)
  • Abdominal pain (Occasional)

Adverse Reactions - Serious

  • Hepatotoxicity (Rare)
  • Cardiac arrhythmias (QT prolongation) (Rare)
  • Severe skin reactions (Stevens-Johnson syndrome) (Rare)

Drug-Drug Interactions

  • Concurrent use with drugs that prolong QT interval (e.g., certain antiarrhythmics, methadone)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor liver function tests, renal function, and electrolytes.

Diagnoses:

  • Risk for hepatotoxicity
  • Risk for QT prolongation

Implementation: Administer with or without food; monitor for signs of hepatotoxicity and arrhythmias.

Evaluation: Assess for resolution of fungal infection symptoms and monitor adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report symptoms of liver problems (e.g., jaundice, dark urine).
  • Avoid alcohol and hepatotoxic medications.
  • Inform providers of all medications and herbal supplements.

Special Considerations

Black Box Warnings:

  • Fetal risk—Category D; avoid during pregnancy unless clearly necessary.

Genetic Factors: Some populations may have increased susceptibility to adverse effects.

Lab Test Interference: May cause false increase in serum transaminases, bilirubin, and alkaline phosphatase.

Overdose Management

Signs/Symptoms: Nausea, vomiting, hallucinations, seizures, liver injury.

Treatment: Supportive care, activated charcoal if recent ingestion, dialysis in severe cases.

Storage and Handling

Storage: Store at room temperature away from moisture, heat, and light.

Stability: Stable for at least 2 years when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.