Test ID: FLUCO
Fluconazole, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring fluconazole therapy to guide dose adjustment and ensure adequate coverage while avoiding high concentrations associated with toxicity, especially in patients who have severely compromised renal function, for those who are undergoing dialysis, or for those where absorption may be impacted
Routine drug monitoring is not indicated in most patients
Method Name A short description of the method used to perform the test
High-Performance Liquid Chromatography (HPLC)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Fluconazole (Diflucan)
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Red top
Specimen Volume: 2 mL
Collection Instructions: Spin down within 2 hours of draw.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | Mild OK; Gross reject |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Refrigerated (preferred) | 14 days |
| Ambient | 14 days | |
| Frozen | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Fluconazole (Diflucan) is a synthetic triazole antifungal agent for either intravenous or oral administration. It is indicated for treatment of fungal infections caused by Candida albicans and meningitis caused by Cryptococcus neoformans.
Fluconazole is <10% protein bound and has a volume of distribution (averaging 0.9 L/kg) indicating that it distributes into tissues.
Fluconazole is cleared predominantly by the kidney. Ninety plus percent of administered fluconazole is excreted in the urine as parent drug. The apparent elimination half-life is approximately 30 hours (range 20-50 hours). Compromised renal function significantly decreases the rate of elimination and causes fluconazole to accumulate. Distribution and elimination are similar in adults, children as young as age 2 months, and in geriatric patients.(1,2)
Fluconazole does not undergo extensive hepatic metabolism. However, fluconazole is a potent inhibitor of CYP2C9, which affects drugs metabolized by this system such as benzodiazepines, cyclosporine, statins, phenytoin, sirolimus, tacrolimus, and warfarin.
Fluconazole is generally well tolerated, but toxicity can occur at high serum concentration. Hepatic toxicity has been observed in renally impaired patients treated with fluconazole. Anaphylaxis, seizures, toxic epidermal necrosis, vomiting, and diarrhea also may occur.(2)
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
4.0-20 mcg/mL
Interpretation Provides information to assist in interpretation of the test results
Serum concentration of fluconazole correlates with dose (typically 0.1-0.6 gm administered every 24 hours):
-A 0.2 gm dose produces a peak serum concentration (within 30-60 minutes of infusion) of 4.0 to 8.0 mcg/mL in adults
-A 0.4 gm dose produces a peak serum concentration of 8.0 to 16 mcg/mL
Optimal peak serum concentrations vary according to indication. Peak serum concentrations <4.0 mcg/mL are likely to be ineffective, while peak concentrations >20 mcg/mL are unlikely to provide increased efficacy and may predispose the patient to toxicity.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Naltrexone and naproxen interfere with fluconazole, causing an artifactual increase in the fluconazole concentration. Pentoxifylline and hydrocodone interfere with the internal standard peak, causing an artifactual decrease in the fluconazole concentration. Physiologic serum concentrations of naltrexone and hydrocodone are not likely to interfere. Naproxen and pentoxifylline are significant interferences
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Mandall GL: In Principles and Practice of Infectious Disease. Philadelphia, Churchill Livingstone, 2000
2. Hardman JG, Limbird LE: In The Pharmacologic Basis of Therapeutics. 9th edition. New York, McGraw-Hill Book Company, 1996, p 1183
Method Description Describes how the test is performed and provides a method-specific reference
HPLC (Cociglio M, Brandissou S, Alric R, Bressolle F: High-performance liquid chromatographic determination of fluconazole in plasma. J Chromatogr B Biomed Appl 1996 November 8;686(1):11-17)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Thursday; 9 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
80299
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 82522 | Fluconazole, S | 10987-6 |
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