Fluconazole Dosage

This dosage information may not include all the information needed to use Fluconazole safely and effectively. See additional information for Fluconazole.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Vaginal Candidiasis

150 mg orally as a single dose

Usual Adult Dose for Oral Thrush

200 mg on the first day followed by 100 mg orally or IV once a day
Therapy should be continued for at least 2 weeks to decrease the likelihood of relapse.

Dosages of 100 to 200 mg orally once a day have been recommended for long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent recurrence or relapse of oropharyngeal candidiasis in HIV-infected patients who have experienced frequent or severe episodes.

Usual Adult Dose for Candidemia

Systemic candidiasis: 400 mg on the first day followed by 200 mg IV or orally once a day

Optimal therapeutic dosage and therapy duration have not been established for systemic Candida infections (including candidemia, disseminated candidiasis, and pneumonia). Doses up to 400 mg/day have been used.

Therapy should be continued for at least 4 weeks and at least 2 weeks following resolution of symptoms.

Usual Adult Dose for Fungal Pneumonia

Systemic candidiasis: 400 mg on the first day followed by 200 mg IV or orally once a day

Optimal therapeutic dosage and therapy duration have not been established for systemic Candida infections (including candidemia, disseminated candidiasis, and pneumonia). Doses up to 400 mg/day have been used.

Therapy should be continued for at least 4 weeks and at least 2 weeks following resolution of symptoms.

Usual Adult Dose for Fungal Infection - Disseminated

Systemic candidiasis: 400 mg on the first day followed by 200 mg IV or orally once a day

Optimal therapeutic dosage and therapy duration have not been established for systemic Candida infections (including candidemia, disseminated candidiasis, and pneumonia). Doses up to 400 mg/day have been used.

Therapy should be continued for at least 4 weeks and at least 2 weeks following resolution of symptoms.

Usual Adult Dose for Esophageal Candidiasis

200 mg on the first day followed by 100 mg orally or IV once a day; doses up to 400 mg/day may be used, based on medical judgment of patient's response to therapy

Therapy should be continued for at least 3 weeks and for at least 2 weeks following resolution of symptoms.

Dosages of 100 to 200 mg orally once a day have been recommended for long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent recurrence or relapse of esophageal candidiasis in HIV-infected patients who have experienced frequent or severe episodes.

Usual Adult Dose for Candida Urinary Tract Infection

50 to 200 mg orally or IV once a day

Usual Adult Dose for Fungal Peritonitis

Candida peritonitis: 50 to 200 mg orally or IV once a day

Usual Adult Dose for Cryptococcal Meningitis - Immunocompetent Host

Acute: 400 mg on the first day followed by 200 to 400 mg IV or orally once a day, based on medical judgment of patient's response to therapy

Therapy should be continued for 10 to 12 weeks after cerebrospinal fluid culture is negative. Patients should be monitored for at least 1 year for relapse.

Usual Adult Dose for Cryptococcal Meningitis - Immunosuppressed Host

Acute: 400 mg on the first day followed by 200 to 400 mg IV or orally once a day, based on medical judgment of patient's response to therapy

Therapy should be continued for 10 to 12 weeks after cerebrospinal fluid culture is negative. Patients should be monitored for at least 1 year for relapse.

Suppression of relapse in patients with AIDS: 200 mg once a day

Usual Adult Dose for Fungal Infection Prophylaxis

Prevention of candidiasis in bone marrow transplantation patients: 400 mg orally or IV once a day

Patients who are anticipated to have severe granulocytopenia (less than 500 neutrophils/mm3) should start fluconazole prophylaxis several days before the anticipated onset of neutropenia, and continue for 7 days after the neutrophil count rises above 1000 cells/mm3.

Usual Adult Dose for Coccidioidomycosis - Meningitis

200 to 800 mg IV or orally once a day

Dosages of 400 to 800 mg IV or orally once a day have been recommended in patients with AIDS.

Therapy should be continued for 1 year after normalization of the cerebrospinal fluid to prevent relapse. Many experts recommend that fluconazole therapy be continued for the lifetime of the patient.

Usual Adult Dose for Coccidioidomycosis

400 mg orally or IV once a day

Therapy ranges from many months to years in duration. Relapse is common. Lifetime therapy is recommended for HIV positive or AIDS patients.

Usual Adult Dose for Cryptococcosis

400 mg orally or IV once a day

The duration of therapy should be about 8 weeks. Patients should be monitored for at least 1 year for relapse. Fluconazole 200 mg orally once a day may be used for suppression of relapse. Lifelong therapy is required for HIV positive or AIDS patients.

Usual Adult Dose for Histoplasmosis

400 to 800 mg IV or orally once a day

The duration of therapy should be 6 to 12 months in patients without meningitis or endocarditis, which require more prolonged therapy.

Usual Adult Dose for Chronic Mucocutaneous Candidiasis

100 to 200 mg orally or IV once a day
Generally requires long term maintenance therapy.

Usual Adult Dose for Blastomycosis

400 to 800 mg orally once a day
Therapy should be continued for at least 6 months.

Usual Adult Dose for Onychomycosis - Fingernail

150 to 300 mg orally once a week
Therapy should be continued for 3 to 6 months.

Usual Adult Dose for Onychomycosis - Toenail

150 to 300 mg orally once a week
Therapy should be continued for 6 to 12 months.

Usual Pediatric Dose for Esophageal Candidiasis

2 weeks or younger (gestational age 26 to 29 weeks): 3 to 12 mg/kg orally or IV every 72 hours

Greater than 2 weeks: 6 mg/kg on the first day followed by 3 mg/kg orally or IV once a day; doses up to 12 mg/kg/day may be used, based on medical judgment of patient's response to therapy

Treatment should continue for at least 3 weeks and for at least 2 weeks following the resolution of symptoms.

Usual Pediatric Dose for Oral Thrush

2 weeks or younger (gestational age 26 to 29 weeks): 3 mg/kg orally or IV every 72 hours
Greater than 2 weeks: 6 mg/kg on the first day followed by 3 mg/kg orally or IV once a day

Treatment should continue for at least 2 weeks to decrease the likelihood of relapse.

Usual Pediatric Dose for Candidemia

Systemic Candida infections:
2 weeks or younger (gestational age 26 to 29 weeks): 6 to 12 mg/kg IV or orally every 72 hours
Greater than 2 weeks: 6 to 12 mg/kg/day, IV or orally

Usual Pediatric Dose for Fungal Infection - Disseminated

Systemic Candida infections:
2 weeks or younger (gestational age 26 to 29 weeks): 6 to 12 mg/kg IV or orally every 72 hours
Greater than 2 weeks: 6 to 12 mg/kg/day, IV or orally

Usual Pediatric Dose for Cryptococcal Meningitis - Immunocompetent Host

Acute:
2 weeks or younger (gestational age 26 to 29 weeks): 6 to 12 mg/kg IV or orally every 72 hours

Greater than 2 weeks: 12 mg/kg on the first day followed by 6 to 12 mg/kg IV or orally once a day, based on medical judgment of patient's response to therapy

Therapy should be continued for 10 to 12 weeks after cerebrospinal fluid culture is negative.

Usual Pediatric Dose for Cryptococcal Meningitis - Immunosuppressed Host

Acute:
2 weeks or younger (gestational age 26 to 29 weeks): 6 to 12 mg/kg IV or orally every 72 hours

Greater than 2 weeks: 12 mg/kg on the first day followed by 6 to 12 mg/kg IV or orally once a day, based on medical judgment of patient's response to therapy

Therapy should be continued for 10 to 12 weeks after cerebrospinal fluid culture is negative.

For suppression of relapse in children with AIDS: 6 mg/kg once a day

Renal Dose Adjustments

The manufacturer recommends caution when administering this drug to patients with renal dysfunction.

Single dose therapy: No adjustment recommended.

Multiple dose therapy:
CrCl 50 mL/min or less (no dialysis): 50 to 400 mg loading dose followed by 50% of usual dose; further adjustment may be needed depending on clinical condition

Liver Dose Adjustments

The manufacturer recommends caution when administering this drug to patients with liver dysfunction.

Precautions

Fluconazole may potentially interact with many drugs. Fluconazole is a potent CYP450 2C9 inhibitor and a moderate CYP450 3A4 inhibitor. The combination of fluconazole with drugs metabolized via CYP450 2C9 and/or 3A4 (especially those with a narrow therapeutic window) should be used with caution and the patients should be carefully monitored. Coadministration of drugs known to prolong the QT interval and which are metabolized via CYP450 3A4 (such as cisapride, astemizole, pimozide, and quinidine) is contraindicated in patients administered fluconazole. These interactions may be serious and/or life threatening. Patients should be advised to report all concurrent medications they are taking.

Fluconazole has been associated with rare cases of serious hepatic toxicity, including fatalities, primarily in patients with serious underlying medical conditions. No obvious relation to total daily dose, duration of therapy, sex, or age of the patient has been observed. The hepatotoxicity is usually, but not always, reversible upon discontinuation of the drug. In patients who develop abnormal liver function tests while taking fluconazole, it is recommended that they are monitored for the development of more severe hepatic injury. The drug should be discontinued if clinical signs and symptoms of liver disease develop that may be attributable to fluconazole.

Patients have rarely developed exfoliative skin disorders during therapy with fluconazole. In patients with serious underlying diseases (predominantly AIDS and malignancy), these disorders rarely resulted in a fatal outcome. Patients who develop rashes during therapy with fluconazole should be monitored closely and the drug discontinued if lesions progress.

Some azoles, including fluconazole, have been linked with prolongation of the QT interval on the electrocardiogram. During postmarketing experience, there have been rare cases of QT prolongation and torsades de pointes in patients taking fluconazole. Most of these reports involved seriously ill patients with multiple confounding risk factors (such as electrolyte abnormalities, structural heart disease, and concomitant medications) that may have been contributory. Fluconazole should be given with caution to patients with these potentially proarrhythmic conditions.

Fluconazole oral suspension contains sucrose and is not recommended for patients with rare hereditary problems of fructose intolerance, sucrase-isomaltase deficiency, or glucose-galactose malabsorption.

The efficacy of fluconazole has not been determined in infants less than 6 months of age.

Dialysis

Dialysis patients should receive the usual dose following each dialysis session.

Other Comments

In general, a loading dose of twice the daily dose is recommended on the first day of therapy to result in plasma concentrations close to steady-state by the second day of therapy.

Fluconazole may be administered orally or by IV infusion. Fluconazole can be taken without regard to food.

Since oral absorption is rapid and almost complete, the daily dose of fluconazole is the same for oral (tablets and suspension) and IV administration. Absolute doses exceeding 600 mg/day are not recommended.

The IV infusion of fluconazole should be administered at a maximum rate of approximately 200 mg/hour. It has been used safely for up to 14 days.

The daily dose of fluconazole should be based on the infecting organism and the patient's response to therapy. Treatment should be continued until clinical parameters or laboratory tests indicate active fungal infection has subsided. An inadequate treatment period may lead to recurrence of active infection. Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually require maintenance therapy to prevent relapse.

On occasion, dizziness or seizures may occur; this should be considered when driving or operating machinery.

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