Adrenal insufficiency has been reported in patients receiving azoles, including fluconazole. On the sixth day of dosing, fluconazole increased the midazolam AUC and Cmax by 259% and 74%, respectively. Fluconazole is primarily cleared by renal excretion as unchanged drug. If tolvaptan and fluconazole are concomitantly administered, the tolvaptan dose should be reduced as instructed in the tolvaptan prescribing information and the patient should be frequently monitored for any adverse reactions associated with tolvaptan. 200 mg/100 mL (2 mg/mL). Voriconazole: Avoid concomitant administration of voriconazole and fluconazole. A few published case reports describe a pattern of distinct congenital anomalies in infants exposed in utero to high dose maternal fluconazole (400 to 800 mg/day) during most or all of the first trimester. Oropharyngeal and esophageal candidiasis. Coadministration of other drugs known to prolong the QT interval and which are metabolized via the enzyme CYP3A4 such as cisapride, astemizole, erythromycin, pimozide, and quinidine are contraindicated in patients receiving fluconazole. Such use could result in air embolism due to residual air being drawn from the primary container before administration of the fluid from the secondary container is completed. If leaks are found, discard solution as sterility may be impaired. Fluconazole, with or without metabolic activation, was negative in tests for mutagenicity in four strains of S. typhimurium, and in the mouse lymphoma L5178Y system. Maximum dose: 800 mg/dose Usual Adult Dose for: Vaginal Candidiasis Oral Thrush Candidemia Fungal Pneumonia Fungal Infection - Disseminated Systemic Candidiasis Esophageal Candidiasis Candida Urinary Tract Infection Fungal Peritonitis Cryptococcal Meningitis - Immunocompetent Host Cryptococcal Meningitis - Immunosuppressed Host Cryptococcosis Fungal Infection Prophylaxis Cutaneous or lymphocutaneous infection: 400 to 800 mg IV or orally once a day voriconazole will increase the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The individual AUC values of norethindrone decreased very slightly (<5%) in 3 of the 21 subjects after fluconazole treatment. Fluconazole has been shown to be active against most isolates of the following microorganisms both in vitro and in clinical infections. (See CLINICAL PHARMACOLOGY: Drug Interaction Studies.). Dosage adjustment of alfentanil may be necessary. However, the administration of cimetidine 600 mg to 900 mg intravenously over a four-hour period (from one hour before to 3 hours after a single oral dose of fluconazole 200 mg) did not affect the bioavailability or pharmacokinetics of fluconazole in 24 healthy male volunteers. MEDICATION MUST NOT BE USED IN SERIES CONNECTIONS (See CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION.). Thus, multiple-dose use of fluconazole at these doses is unlikely to have an effect on the efficacy of the combined oral contraceptive. The following in vitro data are available, but their clinical significance is unknown.At least 90% of the following fungi exhibit an in vitro MIC less than or equal to the susceptible breakpoint for fluconazole (https://www.fda.gov/STIC) against isolates of similar genus or organism group. The recommended dosage of Fluconazole in Sodium Chloride Injection, USP for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Dosage FAQ What is fluconazole? Of days. Consolidation therapy (after induction therapy): 10 to 12 mg/kg orally once a day for 8 weeks, Maintenance therapy: 6 mg/kg orally once a day, Consolidation therapy (after induction therapy): 10 to 12 mg/kg/day orally in 2 divided doses for 8 weeks, Maintenance therapy in HIV-infected patients: 6 mg/kg orally once a day, Recommended in alternative regimens for acute therapy if flucytosine not tolerated or unavailable or amphotericin B-based therapy not tolerated, Recommended as preferred agent for consolidation therapy; should be followed by secondary prophylaxis, Recommended as preferred therapy for secondary prophylaxis, Recommended as preferred therapy for localized disease and secondary prophylaxis, Recommended as alternative therapy for disseminated disease and severe pulmonary disease. The estimated daily infant dose of fluconazole from breast milk (assuming mean milk consumption of 150 mL/kg/day) based on the mean peak milk concentration (2.61 mcg/mL [range: 1.57 to 3.65 mcg/mL] at 5.2 hours post-dose) was 0.39 mg/kg/day, which is approximately 13% of the recommended pediatric dose for oropharyngeal candidiasis. Fluconazole significantly increased the QTc interval in subjects receiving cisapride 20 mg four times daily for 5 days. plz suggest! Vinca Alkaloids: Although not studied, fluconazole may increase the plasma levels of the vinca alkaloids (e.g., vincristine and vinblastine) and lead to neurotoxicity, which is possibly due to an inhibitory effect on CYP3A4. Remove plastic protector from outlet port at bottom of container. Fluconazole is largely excreted in urine. Comments: 2 weeks or younger (gestational age 26 to 29 weeks): 6 to 12 mg/kg IV or orally every 72 hours Shake the oral suspension well before using; discard unused portion after 2 weeks. Uncomplicated vaginitis: 150 mg orally as a single dose, Management of recurrent vulvovaginal candidiasis (after 10 to 14 days induction therapy): 150 mg orally once a week for 6 months, Complicated vulvovaginal candidiasis: 150 mg orally every 72 hours for 3 doses, Uncomplicated vulvovaginal candidiasis: 150 mg orally as a single dose, Initial therapy for recurrent vulvovaginal candidiasis: 100 to 200 mg orally every 72 hours for 3 doses, Maintenance therapy for recurrent vulvovaginal candidiasis: 100 to 200 mg orally once a week for 6 months, Severe vulvovaginal candidiasis: 150 mg orally every 72 hours for 2 doses, Severe or recurrent vulvovaginal candidiasis: 100 to 200 mg orally once a day for at least 7 days, Suppressive therapy for vulvovaginal candidiasis: 150 mg orally once a week, Unless frequent or severe recurrences, suppressive therapy generally not recommended, Moderate to severe oropharyngeal candidiasis: 100 to 200 mg IV or orally once a day for 7 to 14 days, Initial episodes of oropharyngeal candidiasis: 100 mg orally once a day for 7 to 14 days, Suppressive therapy for oropharyngeal candidiasis: 100 mg orally once a day or 3 times a week. Duration of therapy: 10 to 12 weeks after CSF culture is negative Because elderly patients are more likely to have decreased renal function, care should be taken to adjust dose based on creatinine clearance. There was no significant difference in ethinyl estradiol or levonorgestrel AUC after the administration of 50 mg of fluconazole. Comments: IDSA Recommendations: (See PRECAUTIONS.). Refer to complete directions accompanying set. Spontaneous abortions and congenital abnormalities have been suggested as potential risks associated with 150 mg of fluconazole as a single or repeated dose in the first trimester of pregnancy based on retrospective epidemiological studies. Duration of therapy: At least 3 weeks and for at least 2 weeks after symptoms resolve Dose of 12 mg/kg IV or orally once a day may be used in patients older than 2 weeks based on clinical judgment of patient response; this correlates to 12 mg/kg IV or orally every 72 hours in premature newborns during their first 2 weeks of life. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. In normal volunteers, the bioavailability of orally administered fluconazole is over 90% compared with intravenous administration. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. The second major mechanism of drug resistance involves active efflux of fluconazole out of the cell through the activation of two types of multidrug efflux transporters; the major facilitators (encoded by MDR genes) and those of the ATP-binding cassette superfamily (encoded by CDR genes). Dosage/Direction for Use Adult Cryptococcal meningitis & cryptococcal infections at other sites 400 mg on the 1st day followed by 200-400 mg once daily. Dosage reduction of zidovudine may be considered. Fluconazole in Sodium Chloride Injection, USP is indicated for the treatment of: Prophylaxis: Fluconazole in Sodium Chloride Injection, USP is also indicated to decrease the incidence of candidiasis in patients undergoing bone marrow transplantation who receive cytotoxic chemotherapy and/or radiation therapy. If a drug's FDA approval could be overturned by any judge, anywhere, anytime the pharmaceutical industry would be . Hydrochlorothiazide: In a pharmacokinetic interaction study, coadministration of multiple-dose hydrochlorothiazide to healthy volunteers receiving fluconazole increased plasma concentrations of fluconazole by 40%. Recommended as preferred therapy in patients with invasive disease who are not critically ill; this drug should be avoided for Candida krusei and C glabrata. Cardiovascular: QT prolongation, torsade de pointes. Careful monitoring of phenytoin concentrations in patients receiving fluconazole and phenytoin is recommended. Patients who develop abnormal liver function tests during Fluconazole in Sodium Chloride Injection, USP therapy should be monitored for the development of more severe hepatic injury. The half-life of theophylline increased from 6.6 1.7 hours to 7.9 1.5 hours. The mean SD theophylline AUC increased 21% 16% (range: -5 to 48%). These effects are similar to those seen in animal studies. Metabolic: Hypercholesterolemia, hypertriglyceridemia, hypokalemia. The psychomotor effects of midazolam were significantly increased after oral administration of midazolam but not significantly affected following intravenous midazolam. Fluconazole is a highly selective inhibitor of fungal cytochrome P450 dependent enzyme lanosterol 14--demethylase. IV fluconazole increased the midazolam AUC and Cmax by 244% and 79%, respectively. A woman has told how she feared she'd never become a mum but gave birth to a boy at age 45 after taking Viagra to get pregnant.. Carin Rockind, 48, welcomed a "miracle" baby after trying to have a . Most of these reports involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications that may have been contributory. Available for Android and iOS devices. Mortality among high risk patients was 33% and 40% for amphotericin B and fluconazole patients, respectively (p=0.58), with overall deaths 14% (9 of 63 subjects) and 18% (24 of 131 subjects) for the 2 arms of the study (p=0.48). And updates DOSAGE and administration. ) individual AUC values of norethindrone decreased very slightly ( < 5 % in... 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