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