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플루코나졸

Fluconazole

Fluconazole (UK-49858)

항진균제 - 트리아졸계POIV개고양이소형 포유류새말

다른 이름: Diflucan · UK-49858 · Fluconazolum

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

2.5-5 mg/kg PO or IV q12-24hPO/IV· q12-24h· 56-84 days
— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증용량경로빈도기간지역
Cryptococcosis, candidiasis, systemic mycoses, nasal aspergillosis2.5-5 mg/kg PO or IV q12-24hPO/IVq12-24h56-84 days🌎 NA
Fungal meningitis5-8 mg/kg PO or IV q12h OR 8-12 mg/kg PO or IV once daily (q24h)PO/IVq12h or q24h56-84 days🌎 NA
Urinary candidiasis5-10 mg/kg PO q24hPOq24h21-42 days🌎 NA
Urinary Candida glabrata infection12 mg/kg PO once dailyPOq24h21-42 days🌎 NA
Cryptococcosis5 mg/kg PO once or twice dailyPOq12h or q24hAt least 2 months beyond resolution of clinical signs🌎 NA
Blastomycosis5 mg/kg PO q12hPOq12h60 days🌎 NA
Cryptococcosis5-15 mg/kg PO q12-24hPOq12-24h6-10 months🌎 NA
Treatment of Malassezia (may be safer than itraconazole or ketoconazole in dogs with hepatic disease)5 mg/kg PO once dailyPOq24h—🌎 NA
Systemic treatment of Malassezia dermatitis5 mg/kg PO once dailyPOq24h—🌎 NA
Recurrent Malassezia dermatitis5 mg/kg PO 3 times per weekPO3 times per week—🌎 NA
Systemic treatment of Malassezia dermatitis2-5 mg/kg PO once daily (q24h)POq24h—🌎 NA
Nasal aspergillosis (alternative to itraconazole or terbinafine)2.5-5 mg/kg PO q12hPOq12h3-6 months🌎 NA
  • Cryptococcosis, candidiasis, systemic mycoses, nasal aspergillosis: Often treat neurologic ocular cryptococcosis for at least 12 weeks or 2 weeks after CSF exam shows resolution
  • Nasal aspergillosis (alternative to itraconazole or terbinafine): Cure rates up to 60%

고양이

적응증용량경로빈도기간지역
Nasal or dermal cryptococcosis5-10 mg/kg PO q12-24h, or 10 mg/kg PO q24hPOq12-24h—🌎 NA
CNS, intraocular, or multisystemic cryptococcosis50-100 mg/cat PO or IV q12hPO/IVq12h—🌎 NA
CNS, intraocular or multisystemic mycoses50 mg/cat PO once daily (q24h)POq24h—🌎 NA
Cryptococcosis50 mg (total dose) PO twice dailyPOq12h1 month beyond resolution of clinical signs🌎 NA
Cryptococcosis50 mg (total dose) PO twice dailyPOq12hAt least 2 months beyond resolution of clinical signs🌎 NA
  • Nasal or dermal cryptococcosis: For most infections, 50 mg/cat PO once daily achieves adequate therapeutic levels
  • CNS, intraocular, or multisystemic cryptococcosis: Often treat neurologic ocular cryptococcosis for at least 12 weeks or 2 weeks after CSF exam shows resolution

소형 포유류

적응증용량경로빈도기간지역
General (Rabbits)25-43 mg/kg slow IV q12hIVq12h—🌎 NA

새

적응증용량경로빈도기간지역
Candidiasis (cockatoos, parrots)20 mg/kg PO q24-48h or 10 mg/kg PO q24hPOq24-48h—🌎 NA
Candidiasis (cockatiels)10 mg/kg fluconazole PO suspension and 100 mg/mL fluconazole treated drinking waterPO——🌎 NA
Alternate treatment of aspergillosis5-10 mg/kg PO once dailyPOq24hup to 6 weeks🌎 NA
  • Candidiasis (cockatoos, parrots): Likely effective for C. albicans. C. galabrata and C. papasilosis may have higher MICs.
  • Candidiasis (cockatiels): Maintained plasma levels above the MIC for most strains of Candida albicans
  • Alternate treatment of aspergillosis: With or after amphotericin B

말

적응증용량경로빈도기간지역
C. immitis infection or Candida bacteremiaLoading dose of 14 mg/kg followed by 5 mg/kg PO once dailyPOq24h—🌎 NA
Fungal keratitis1 mg/kg PO q24hPOq24h—🌎 NA
  • Fungal keratitis: Anecdotal reports of successful treatment

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

플루코나졸은 전신성 ​트리아졸계 항진균제​입니다. 케토코나졸과 같은 초기 1세대 아졸계 약물과 달리 친수성이 높아 ​중추신경계(CSF)​, ​안구​, ​비뇨기계​로의 침투력이 매우 뛰어납니다.

​임상 요점:​ 흡수에 산성 위 환경이 필요하지 않아 제산제 치료를 받는 환자에서도 경구 생체이용률이 매우 안정적입니다. 또한 케토코나졸에 비해 포유류의 시토크롬 P450 효소에 대한 친화력이 훨씬 낮아 포유류의 스테로이드 호르몬 합성에 미치는 영향이 최소화되며 일반적으로 부작용이 적습니다.

작용 기전

Fluconazole acts by inhibiting the fungal cytochrome P450-dependent enzyme lanosterol 14-α-demethylase.

Lanosterol → (blocked by fluconazole) → Ergosterol

This depletion of ergosterol disrupts the synthesis of the fungal cell membrane, increasing its permeability and causing leakage of essential cellular contents. It also impairs the uptake of purine and pyrimidine precursors. Fluconazole is primarily fungistatic.

안전성·주의사항

금기사항

  • Hypersensitivity to fluconazole or other azole antifungals
  • Budgerigars (reportedly toxic)
  • Pregnant animals
  • Lactating animals

부작용

  • Inappetence
  • Vomiting
  • Diarrhea
  • Hepatotoxicity (rare)
  • Headache (humans)
  • Increased liver enzymes (humans)
  • Exfoliative skin disorders (humans)
  • Thrombocytopenia (humans)
  • Nausea
  • Diarrhoea

주의

Use with caution in patients with hepatic impairment. Because fluconazole is eliminated primarily by the kidneys, doses or dosing intervals may need to be adjusted in patients with renal impairment. Safety during pregnancy has not been established (FDA Category C); use with caution in nursing dams as it is excreted in milk. Reportedly toxic to budgerigars.

약물 상호작용

Amphotericin B

May be antagonistic against Aspergillus or Candida; clinical importance unclear

Buspirone

Plasma concentrations of buspirone may be elevated

Cisapride

May increase cisapride levels and the possibility for toxicity

Corticosteroids

May inhibit the metabolism of corticosteroids; potential for increased adverse effects

Cyclophosphamide

May inhibit the metabolism of cyclophosphamide and its metabolites; potential for increased toxicity

Cyclosporine

Increases cyclosporine levels; dosage of cyclosporine may need to be decreased by 29%-51%

Diuretics, Thiazides

Increased fluconazole concentrations

Fentanyl/Alfentanil

May increase fentanyl levels

Midazolam

Increased midazolam levels and effects

NSAIDs

May increase NSAID plasma levels; increased risk for adverse effects

Quinidine

Increased risk for cardiotoxicity

Rifampin

May decrease fluconazole efficacy; fluconazole may increase rifampin levels

Theophylline/Aminophylline

Increased theophylline concentrations

Tricyclic Antidepressants

May exacerbate the effects of tricyclic antidepressants (e.g., clomipramine, amitriptyline)

Sulfonylurea Antidiabetic Agents

May increase levels of agents like glipizide or glyburide; hypoglycemia possible

Vincristine/Vinblastine

May inhibit vinca alkaloid metabolism

Warfarin

May cause increased prothrombin times

TheophyllineModerate

Fluconazole inhibits cytochrome P450-dependent liver enzymes, which may increase plasma theophylline concentrations.

TerfenadineMajor

Co-administration has led to terfenadine toxicity in humans.

CiclosporinMajor

Fluconazole increases ciclosporin blood levels.

모니터링

  • Clinical efficacy
  • Liver function tests (occasional, with long-term therapy)
  • Liver enzyme panel (ALT, AST, ALP, Bilirubin) prior to and during prolonged therapy
  • Renal function (BUN, Creatinine)
  • Resolution of clinical signs of fungal infection
  • Therapeutic drug monitoring for concurrent medications like ciclosporin or theophylline

약동학

흡수

Rapidly and nearly completely absorbed (90%) after oral administration. Gastric pH or the presence of food do not appreciably alter oral bioavailability.

분포

Low protein binding and widely distributed throughout the body. Penetrates well into the CSF, eye, and peritoneal fluid.

대사

Minimal hepatic metabolism compared to other azole antifungals.

배설

Eliminated primarily via the kidneys and achieves high concentrations in the urine.

과다투여

There is limited information on acute toxicity in domestic animals. In rodents, massive overdoses (1-2 g/kg) caused respiratory depression, salivation, lacrimation, urinary incontinence, and cyanosis, leading to death within several days.

​Treatment:​ If a massive overdose occurs, consider gut emptying (emesis or gastric lavage) if recent, and provide supportive therapy as required. Fluconazole may be removed by hemodialysis or peritoneal dialysis.

제품

제형

  • Tablets
  • Powder for oral suspension
  • Injection
  • 150 mg oral capsule
  • 200 mg oral capsule
  • 40 mg/ml oral suspension
  • 2 mg/ml injectable solution

인용의약품

  • Fluconazole Oral Tablets: 50 mg, 100 mg, 150 mg, & 200 mg
  • Fluconazole Powder for Oral Suspension: 10 mg/mL & 40 mg/mL (when reconstituted)
  • Fluconazole Injection: 2 mg/mL in 100 mL or 200 mL bottles or Viaflex Plus
  • Diflucan 50 mg, 150 mg, 200 mg capsules
  • Diflucan 40 mg/ml oral suspension
  • Diflucan 2 mg/ml injectable solution

규제 현황

European Union✓ 승인됨처방전의약품EMA
🐕 Dogs🐈 Cats

POM (Prescription Only Medicine)

United Kingdom✓ 승인됨처방전의약품VMD
🐕 Dogs🐈 Cats

POM-V (Prescription Only Medicine - Veterinarian)

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Tablets should be stored at temperatures less than 30°C in tight containers. Injection should be stored at 5-30°C (5-25°C for Viaflex bags); avoid freezing. Do not add additives to the injection.

보호자 정보

  • ​인내심이 필요합니다:​ 진균 감염은 치료하는 데 오랜 시간이 걸립니다. 치료는 보통 수주에서 수개월 동안 지속됩니다. 반려동물의 상태가 좋아 보이더라도 감염이 재발할 수 있으므로 일찍 약을 중단하지 마십시오.
  • ​투여 방법:​ 플루코나졸은 음식과 함께 먹이든 빈속에 먹이든 매우 잘 흡수됩니다.
  • ​부작용 관찰:​ 일반적으로 매우 안전하지만 식욕 부진, 구토 또는 설사가 있는지 관찰하십시오. 이러한 증상이 나타나면 수의사에게 연락하십시오.
  • ​비용:​ 치료 기간이 길어 비용이 부담될 수 있으나, 제네릭 의약품이 출시되어 이전보다 저렴해졌습니다.

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