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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(ref 1)
| eGFR (ml per minute/1.73m2) | Dose |
|---|---|
| Greater than 10 | Dose as in normal renal function |
| Less than 10 | Give usual dose as loading dose, then give 50% of dose for subsequent doses |
| Renal replacement therapy | Consult pharmacy/specialist literature |
* the manufacturers recommend a 50% dose reduction when GFR <50ml/minute/1.73m2. However, the Renal Drug Handbook (ref 2) recommend a dose reduction only when GFR is < 10ml/minute/1.73m2. The severity of infection/clinical condition of the patient should guide prescribers as to the level of reduction which is appropriate. (ref 2)
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 May 2021
1. GUH anti-microbial guideline
2. Renal Drug Database accessed on line 9th Dec 2021
3. Kidd, P. Personal opinion only. 14th Dec 2021
Therapeutic classification
Antifungal drugs