Generic Name

Fluconazole

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Classification

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

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.