A triazole antifungal active against Candida species and certain other fungi. In tactical and deployment medicine, fluconazole is used for vulvovaginal candidiasis, mucosal candidiasis, and prophylaxis or treatment of fungal infections that complicate prolonged antibiotic use in austere environments.

Pharmacology and Actions

Fluconazole inhibits fungal cytochrome P450 14-alpha-demethylase, blocking conversion of lanosterol to ergosterol. The result is disruption of fungal cell membrane synthesis. Spectrum includes Candida albicans (well covered), C. parapsilosis, C. tropicalis, Cryptococcus neoformans, Coccidioides immitis, and Histoplasma capsulatum. C. glabrata and C. krusei have intrinsic or acquired resistance and require alternative agents.

Indications

Vulvovaginal candidiasis (single-dose treatment)
Oropharyngeal and esophageal candidiasis (thrush)
Candidemia and invasive candidiasis (hospital indications)
Cryptococcal meningitis (consolidation and maintenance therapy)
Prophylaxis against fungal infections in immunocompromised patients
Coccidioidomycosis (deployment medicine in endemic regions)

Absolute Contraindications

Known fluconazole or azole antifungal allergy
Concurrent use of QT-prolonging medications with established interactions
Severe hepatic impairment
Pregnancy (high-dose chronic therapy; single-dose use for vaginitis appears safe)

Precautions and Side Effects

Hepatotoxicity is the most significant adverse effect and ranges from asymptomatic transaminase elevations to fulminant hepatic failure. QT interval prolongation can occur. Drug interactions are extensive due to CYP450 inhibition; review medication list before administration. Common side effects include nausea, headache, abdominal pain, and rash. Stevens-Johnson syndrome has been reported. Renal dose adjustment is required for creatinine clearance below 50 mL/min.

Adult Dosing

IV / IO

Severe invasive infection: 400 to 800 mg IV loading dose, then 200 to 400 mg IV daily. Onset: Immediate after infusion

Vulvovaginal candidiasis: 150 mg PO single dose. Oropharyngeal candidiasis: 200 mg PO on day 1, then 100 mg PO daily for 7 to 14 days. Esophageal candidiasis: 200 to 400 mg PO daily for 14 to 21 days. Cryptococcal meningitis consolidation: 400 mg PO daily for 8 weeks. Onset: 1 to 2 hours (excellent oral bioavailability, approximately 90 percent)

Pediatric Dosing

Pediatric dosing varies by indication. Oropharyngeal candidiasis: 6 mg/kg PO on day 1, then 3 mg/kg/day for 7 to 14 days. Maximum 600 mg/day. Pediatric tactical use is uncommon; consult medical control.

Pharmacokinetics

Peak Effect: PO: 1 to 2 hours after dose

Duration: Half-life approximately 30 hours; supports once-daily dosing

Storage and Handling

Store tablets at controlled room temperature (15 to 30 degrees Celsius). Protect from moisture. Oral suspension requires refrigeration after reconstitution. IV preparation is supplied in ready-to-use bags.

Reconstitution:

Tablets require no reconstitution. Oral suspension requires reconstitution per manufacturer instructions and refrigeration. IV bags are ready to infuse.

TCCC and TECC Role

Fluconazole is not part of routine TCCC wound management but has a role in deployment medicine for vulvovaginal candidiasis (operationally relevant for female team members), oral and esophageal candidiasis in casualties on prolonged antibiotic therapy, and as antifungal coverage in austere environments where Candida and certain endemic fungi are concerns. The single-dose 150 mg regimen for vaginal candidiasis is operationally convenient and well-suited to deployment kits.

Field Context

Fluconazole is the antifungal carried in deployment medical kits for two main scenarios: female team members with vulvovaginal candidiasis (single dose, simple, effective) and oral thrush complicating long antibiotic courses. The 150 mg single-dose vaginal candidiasis treatment is operationally elegant: one tablet, no compliance issues. For oral thrush, the 7 to 14 day course requires planning but is far better tolerated than older nystatin regimens. Watch for drug interactions; fluconazole is a significant CYP450 inhibitor.

Common Mistake

Using fluconazole empirically for non-Candida fungal infections. The spectrum has specific gaps (C. glabrata, C. krusei, Aspergillus species) that require alternative agents. The other common error is failing to check for drug interactions; fluconazole can substantially increase levels of warfarin, phenytoin, certain statins, and many other medications.

Last Reviewed May 14, 2026

Reviewer TCCC 2026 Guidelines (01 May 2026); NREMT Paramedic Drug List; FDA labeling.

Drug Class Antibiotic

DEA Schedule Not Controlled

Mission Impact Mission Capable - No Impact

Reference Category TCCC Doctrine

Generic Name Fluconazole

Source: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Committee on Tactical Combat Casualty Care, Joint Trauma System.

Reference URL: https://penntacticalsolutions.com/pages/drug-reference/fluconazole

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This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.

Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.

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Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.

Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.

In a medical emergency, call 911. This reference is not a substitute for emergency medical services.

Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.

Fluconazole

Antibiotic

Mission Capable - No Impact

Adult Dosing

IV/IO	Severe invasive infection: 400 to 800 mg IV loading dose, then 200 to 400 mg IV daily. (Immediate after infusion)
PO	Vulvovaginal candidiasis: 150 mg PO single dose. Oropharyngeal candidiasis: 200 mg PO on day 1, then 100 mg PO daily for 7 to 14 days. Esophageal candidiasis: 200 to 400 mg PO daily for 14 to 21 days. Cryptococcal meningitis consolidation: 400 mg PO daily for 8 weeks. (1 to 2 hours (excellent oral bioavailability, approximately 90 percent))

Pediatric

Contraindications

Known fluconazole or azole antifungal allergy| Concurrent use of QT-prolonging medications with established interactions| Severe hepatic impairment| Pregnancy (high-dose chronic therapy; single-dose use for vaginitis appears safe)

Common Mistake

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