fluconAZOLE

fluconAZOLE (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