fluconAZOLE

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

fluconAZOLE Hazardous Symbol(non-CYTOTOXIC hazardous)

Refer to the Procedure for Safe Handling of Hazardous Drugs (CYTOTOXIC and non-CYTOTOXIC) and Safe Handling of Hazardous Drugs Policy on the LHSC Intranet

Indication

  • fluconAZOLE is a triazole antifungal agent that may be used for prophylaxis against or treatment of mucocutaneous, systemic and cerebrospinal Candida infections, most specifically C. albicans
  • C. glabrata and C. krusei are resistant

Dosage Guidelines

  • Treatment of Systemic Candidiasis, including meningitis:

    • Loading dose 

      25 mg/kg/dose IV/oral may be used in select cases

    • Maintenance dose 

      12 mg/kg/dose IV/oral once daily starting 24 hours after loading dose

  • Treatment of Thrush:

    • Loading dose 

      6 mg/kg/dose oral on day 1

    • Maintenance dose 

      3 mg/kg/dose oral daily x 7 to 14 days

  • Prophylaxis: (For all ELGA neonates or neonates with a weight less than 1000 g at the discretion of Neonatologist)
    • 6 mg/kg/dose IV/oral q72 hr

Duration of prophylaxis should be guided by the presence of risk factors (typically 4 weeks)

Administration

  • Oral
  • IV intermittent slow infusion
  • Doses greater than 6 mg/kg
    • infuse over at least 2 hours
  • Doses 6 mg/kg or less
    • infuse over 1 to 2 hours

Adverse Effects

  • Generally, well tolerated
  • Nausea, vomiting, diarrhea
  • Elevations in liver enzymes, jaundice
  • Rare adverse effects: angioedema, hypokalemia, leucopenia, neutropenia, thrombocytopenia

Comments

  • Periodic monitoring of liver enzymes, renal function tests, potassium, CBC and differential is recommended
  • Use with caution in patients with liver impairment.
  • Dose adjustment required in patients with renal impairment – contact pharmacist.
  • Interferes with metabolism of Phenobarbital, phenytoin, caffeine and midazolam
  • May cause QTc prolongation and torsades de pointes; use caution in patients with concomitant medications or conditions which are arrhythmogenic
  • Avoid using in patients receiving erythromycin

Supplied As

  • 2 mg/mL IV syringe, prepared by Pharmacy for immediate use – RN to send a medication request 30 minutes to 1 hour prior to administration time to receive dose
  • 10 mg/mL oral suspension

References

LexiComp Sick Kids, LexiComp Pediatric and Neonatal