Fluconazole (Diflucan®)

Antifungal Agent, oral and parenteral

Mechanism of Action
Inhibits cell membrane formation, via inhibition on ergosterol synthesis.

Therapeutic Uses
FDA approved: Treatment of candidiasis, crypto coccal meningitis.

Non-FDA
Coccidiosis, aspergillosis, histoplasmosis.

Adverse Drug Events
GI intolerance, rash, Stevens-Johnson’s syndrome, eosinophilia, mild transient increased LFTs.

Patient Monitoring
Rash, LFTs.

Drug-Drug Interactions
Coumadin (↑ pro-time, INR), cyclosporine
(↑cyclosporine levels), phenytoin (↑ phenytoin levels), rifampin (↓ fluconazole level), sulfonylurea (↓ metabolism of sulfonylurea), Seldane & Hisminal (prolong QT interval).

Dosage Forms
Oral tablet, 50, 100, 150, and 200 mg; oral solution, 10, 40 mg/mL; injection, 200 mg/100mL.

Dosage and Administration
Usual dose is 100 mg PO QD; IV dose 200 mg loading dose, followed by 100 mg QD; rate of infusion not to exceed 200 mg for 1 hour.

Compatibilities/Special Administration Techniques
Tablets may be crushed and dissolved in liquids; may give without regard to meals.

Nystatin (Mycostatin®)

Antifungal, oral non-absorbed, topical, vaginal

Mechanism of Action
Binds to ergosterol in fungal plasma membranes, forming pores that allow vital substances to leak out of the cell.

Therapeutic Uses
FDA approved: Treatment and prophylaxis of oral candidiasis (thrush).

Adverse Drug Events
Rare, hypersensitivity.

Patient Monitoring
Monitor for mouth sores, oral candidiasis.

Drug-Drug Interactions
Peridex (antagonist to action of nystatin).

Dosage Forms
Suspension, powder, ointment, vaginal suppository.

Dosage and Administration
Usual dose is 5 mL QID after meals and at bedtime; shake well, swish as long as possible (at least 1-2 minutes), then swallow. Do not eat or drink for 15 minutes after dose.

Compatibilities/Special Administration Techniques
Drug is not absorbed through the GI tract.

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