Indications & Dose: CANDIDEMIA/DISSEMINATED CANDIDA INFECT IV Adult Inf: Loading dose 6 mg/kg BID for first 24h, then MD 3-4 mg/kg BID, Switch to oral therapy, <40 kg: MD 100mg BID, max 300mg/day 2 wk, >40 kg: 200mg BID, max 600mg/day 2 wk Child 2-11 yr: 7mg/kg BID, >12 yr: Loading dose 6mg/kg BID for first 24h, then MD 4 mg/kg BID | DISSEMINATED & EXTRAPULMONARY INFECT IV Adult Loading dose: 6mg/kg q12h first 24h, MD 4mg/kg q12h 6-12 wk, switch to oral therapy <40 kg: 100mg BID, max 300mg/day, >40 kg: 200mg BID, max 600mg/day 6-12 wk | ESOPHAGEAL CANDIDIASIS PO Adult <40 kg: 100mg BID, may increase to 150mg BID, >40 kg: 200mg BID, may increase to 300mg BID 2-3 wk Child 2-11 yr: 200mg BID, >12 yr <40 kg: 100mg BID, > 40kg: 200mg BID 2-3 wk | PO/IV Adult In HIV patients: 200mg BID 2 wk | IV Child 2-11 yr: 7mg/kg BID 2-3 wk | INVASIVE ASPERGILLOSIS PO Child 2-12 yr: 200mg BID, 12-18 yr: <40 kg 200mg BID first 24h, then 100mg BID increase to 150mg BID if needed, >40 kg: 400mg BID first 24h then 200mg BID, increased to 300mg BID if needed | IV Adult Loading dose: 6mg/kg q12h first 24h, MD 4mg/kg q12h 6-12 wk, switch to oral therapy <40 kg: 100mg BID, max 300mg/day, >40 kg: 200mg BID, max 600mg/day 6-12 wk Child 2-12 yr: 7mg/kg BID (reduce to 4mg/kg BID if not tolerated) max 6 month, 12-18 yr: 6mg/kg BID for first 24h, then 4mg/kg BID (reduced to 3mg/kg BID if not tolerated) max 6 month | OROPHARYNGEAL CANDIDIASIS PO Adult 200mg BID 1-2 wk Child 2-11 yr: 200mg BID 1-2 wk | IV Child 7mg/kg BID 1-2 wk | SCEDOSPORIOSIS/FUSARIOSIS PO Child 2-12 yr: 200mg BID, 12-18 yr: <40 kg 200mg BID first 24h, then 100mg BID increase to 150mg BID, >40 kg: 400mg BID first 24h then 200mg BID, increased to 300mg BID if needed | IV Adult Loading dose: 6mg/kg bid for first 24h, then MD 4mg/kg BID, switch to oral therapy, <40 kg: MD 100mg BID, max 300mg/day, >40 kg: 200mg BID, max 600mg/day Child 2-12 yr: 7mg/kg BID (reduce to 4mg/kg BID if not tolerated) max 6 month, 12-18 yr: 6mg/kg BID for first 24h, then 4mg/kg BID(reduced to 3mg/kg BID if not tolerated) max 6 month

Precautions: Arrhythmias/QT prolongation, hepatic impairment

ADR: Serious: increased LFTs, adrenal cortical insufficiency, blood disorders, allergic reaction, AV block, cardiomegaly, cardiomyopathy, CVA, erythema multiforme, optic neuritis, hypoxia, osteoporosis, pancreatitis, postural hypotension, TEN, thrombophlebitis, visual changes, tachycardia, hypokalemia, Others: nausea, vomiting, fever, headache, rash, creatinine increased, photosensitivity, hallucinations

DDI: Serious Ergot derivatives causes ergotism, Barbiturates decreases drug blood level, Rifabutin decreases drug level & increases rifabutin level, Statins/CCBs increased blood levels of these drugs, Warfarin increases prothrombin time, NRTIs/HIV protease inhibitors inhibits drug metabolism, Sulfonylureas levels are increased, Sirolimus/Cyclosporine/Tacrolimus levels increases by drug, Vincristine/Vinblastine neurotoxicity

Diet: 1h before/1h after food

Monitor: LFTs, renal function, serum electrolytes, visual function