Parenteral Manual

Fluconazole

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
DIFLUCAN®
Classification: 
Antifungal
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • Treatment of susceptible fungal infections including oropharyngeal and esophageal candidiasis
  • Serious systemic candidal infections
  • Treatment of cryptococcal meningitis
Reconstitution and Stability: 
  • Supplied as a 2 mg/mL solution
  • Store at room temperature
  • Punctured vial stable 7 days at room temperature
Compatibility: 

- Solutions Compatible: D5W, NS, ringer's lactate

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: acyclovir, cefazolin, dexamethasone, diphenhydramine, ganciclovir, gentamicin, hydrocortisone, KCL, metoclopramide, meropenem, morphine, ondansetron, penicillin G, phenytoin, tobramycin, TPN (amino acids/dextrose), vancomycin, zidovudine

- Incompatible: ampicillin, calcium gluconate, cefotaxime, ceftazidime, cefuroxime, ceftriaxone, clindamycin, diazepam, furosemide, imipenem, pentamidine, piperacillin, ticarcillin, trimethoprim-sulfamethoxazole (if these drugs are given concurrently, flush tubing with normal saline before and after fluconazole)

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES,
Usual dilution: undiluted (2 mg/mL)
Infusion time: 1-4 hours, for doses greater than or equal to 6 mg/kg/day infuse over 2 -4 hours
Infusion rate: do not exceed 200 mg/hour
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • 3-12 mg/kg/day IV once daily
  • Maximum: 800 mg/day

Adults:                 

  • 100-800 mg IV once daily

DOSAGE ADJUSTMENT IN RENAL IMPAIRMENT:

  • CrCl  21-50 mL/minute:  50% of recommended dose OR extend dosing interval to Q48H
  • CrCl   < 20 mL/minute:   25% of recommended dose OR extend dosing interval to Q72H
  • Hemodialysis: usual dose - give after hemodialysis

- Higher doses may be required for certain fungi (other than candida); cryptococcal meningitis

Potential hazards of parenteral administration: 
  • Nausea, vomiting, abdominal pain, diarrhea
  • Headache, dizziness                              
  • Rash and pruritis
  • Transient elevation of liver function tests
Notes: 
  • Daily dose of fluconazole is the same for oral and IV administration
  • Increased serum concentrations of AST, ALT, alkaline phosphatase, total bilirubin; patients with baseline abnormal liver function tests or who develop abnormal liver function tests during therapy should be monitored for the development of more severe hepatic injury
  • Monitor periodic liver function and renal function tests
  • Monitor patients also on warfarin - increased prothrombin time
  • May decrease clearance of cyclosporin, phenytoin, zidovudine
  • Rifampin increases fluconazole metabolism

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