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