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Fluconazole Intravenous for Adults
Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- See Monitoring below
- Consider intravenous to oral switch as soon as possible as excellent bioavailability (use same dose orally).
- There are numerous important interactions - check current BNF
- See under 'Dose' for adjustments required in renal impairment
Available preparations
Fluconazole 200mg per 100ml
Other volumes may be available
Reconstitution
Already in solution
Infusion fluids
Not required - product ready for infusion
Methods of intravenous administration
Intermittent intravenous infusion
- Administer at a maximum rate of 10ml per minute
- Give 200mg over 10 to 30 minutes
- Give 400mg over 20 to 30 minutes
Dose in adults
Normal dose range
- From 50 to 400mg daily (higher loading dose - see below)
- In life threatening infections, the dose can be increased to 400mg twice daily (with Micro/ID involvement)
Cryptococcal infections (including meningitis)
- Loading dose (day 1): give 400mg
- Maintenance dose: give 200mg to 400mg once daily, can be increased in life-threatening infections to 800mg daily (given as 400mg twice daily)
Invasive candidiasis
- Loading dose (day 1): give 400mg twice daily
- Maintenance dose: give 400mg once daily
Prevention of fungal infections in immunocompromised patients (usually given orally)
- Give as 50 to 400mg daily (adjusted according to risk)
Renal impairment *
| eGFR (ml per minute/1.73m2) | Dose |
|---|---|
| 10 to 50 (ref 1,2) |
1st dose: no dose adjustment required Subsequent doses: 50 to 100% of usual dose |
| Less than 10 (ref 1,2) |
1st dose: no dose adjustment required Subsequent doses: 50% of usual dose |
| Renal replacement therapy | Consult pharmacy/specialist literature |
* Note on renal dose adjustment
- The manufacturers recommend the normal dose for the 1st dose (loading) and then a 50% dose reduction for 2nd and subsequent doses when eGFR <50ml/minute/1.73m2
- However, the Renal Drug Database (ref 2) recommend a dose reduction when GFR is < 10ml/minute
- The severity of infection/clinical condition of the patient should guide prescribers as to the level of reduction which is appropriate
Hepatic impairment: Use with caution due to limited data
Monitoring
- Monitor LFTs
- Stevens Johnson syndrome and Toxic epidermal necrolysis have been reported rarely with fluconazole
- Monitor QTc interval
Further information
- The SPC suggests a daily dose of 800mg in some situations - however it does not specifically state the rate and frequency at which these doses were given. Since QT interval prolongation has been reported consider giving as 400mg TWICE daily(ref 3)
Storage
Store below 250C
References
Fluconazole (Braun) SPC March 2024
1. GUH anti-microbial guideline
2. Renal Drug Database accessed on line 6th March 2025
3. Local expert opinion March 2025
Therapeutic classification
Antifungal drugs