Administration of Fluconazole via Nasogastric Tube

Pharmacokinetics and Bioavailability

The oral bioavailability of fluconazole is excellent, approximately 90% of IV concentrations, and is not affected by food consumption, gastric pH, or disease state, according to the Infectious Diseases Society of America 1

Flush the tube with at least 30 mL of water before, between, and after each medication to prevent tube occlusion, as recommended by the American Society for Parenteral and Enteral Nutrition 2, 3
Administer medications individually through the tube—never mix multiple drugs together, following guidelines from the American Society for Parenteral and Enteral Nutrition 2, 3
Use appropriate ENFit-standard syringes and connectors to avoid misconnection errors, as suggested by the American Society for Parenteral and Enteral Nutrition 2

Confirm the tube tip location is in the stomach, as fluconazole absorption occurs primarily in the stomach and proximal small bowel, according to the National Comprehensive Cancer Network 4
Administration distal to the stomach (e.g., directly into duodenum) may result in reduced drug availability, as noted by the American Society for Parenteral and Enteral Nutrition 2, 3
Consider renal function, as fluconazole elimination is almost entirely renal and dose reduction is needed when creatinine clearance is <50 mL/minute, according to the Infectious Diseases Society of America 1

Standard loading dose of 800 mg (12 mg/kg) followed by 400 mg (6 mg/kg) daily for invasive candidiasis, as recommended by the Infectious Diseases Society of America 1