FLUCONAZOLE

Drug type

Anti fungal

Main indication,

- Crypto meningitis

- resistant candidosis and involvment of oeusophagus

- prevention crypto relapse

- prevention of mycotic infection when high dose of corticoids

- Cases of resistance to itraconazole (no cross resistance between fluco and itraconazole)

 

Dose

- severe or generalized mycotic infection (skin crypto, lungs/skin penicilliosis, eusophagial candidas....) : 400 mg once a day (or 200mg x 2)

- cryptococcal meningitis: 400 mg once a day (or 200mg x 2) Some clinicians prefer a loading dose of 400 mg two times a day for two days, then 400 mg a day... In our hospice (no ampho), for severe case, we give 200mg x 3 during one week, then 400 mg a day...

- Prevention of mycotic problems when use high dose of corticoids 200mg x 1

- Adults with impaired renal function require an adjustment in dose

- Antacids & Anticholinergics/antispasmodics & cimetidin: decrease absorption of itraconazole patients should be advised to take these medications at least 2 hours after taking itraconazole

Drug interactions

- Fluconazole increase level of benzodiazepines, clarithromycin, phenitoin & rifabutin

- Fluconazole level is reduce with rifampicin & rifabutin ; this may lead to clinical failure or relapse

- fluconazole increase theophylline concentrations which may lead to toxicity

Contraindication

- severe renal failure

- liver problems

Possible side/adverse effect

- GI intolerance (usualy do not require discontunation)

- Rash

- Increased risk of exfoliative skin disorders, including Stevens-Johnson syndrome

- agranulocytosis and thrombocytopenia.

- All azole predispose to resistance!!!

Other informations

- Store below 40 °C, preferably between 15 and 30 °C, in a well-closed container.