Fluconazole (Diflucan) does not require an acidic environment, as does ketoconazole, for gastrointestinal absorption. About 80 to 90% of an orally administered dose is absorbed, yielding high serum drug levels. The half-life of the drug is 27 to 37 hours, permitting once-daily dosing in patients with normal renal function. Only 11% of circulating drug is bound to plasma proteins. The drug penetrates widely into most body tissues, including normal and inflamed meninges. Cerebrospinal fluid levels are 60 to 80% of serum levels, permitting effective treatment for fungal meningitis. About 80% of the drug is excreted unchanged in the urine, and 10% is excreted unchanged in the feces. Dosage reductions are required in the presence of renal insufficiency.
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