fluconazole

Pronunciation

Generic Name: fluconazole (floo KOE na zole)
Brand Name: Diflucan

What is fluconazole?

Fluconazole is an antifungal medicine.

Fluconazole is used to treat infections caused by fungus, which can invade any part of the body including the mouth, throat, esophagus, lungs, bladder, genital area, and the blood.

Fluconazole is also used to prevent fungal infection in people with weak immune systems caused by cancer treatment, bone marrow transplant, or diseases such as AIDS.

Fluconazole may also be used for purposes not listed in this medication guide.

What is the most important information I should know about fluconazole?

Certain other drugs can cause unwanted or dangerous effects when used with fluconazole, especially cisapride, erythromycin, pimozide, and quinidine. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.

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What should I discuss with my healthcare provider before taking fluconazole?

You should not use this medicine if you are allergic to fluconazole, or if you also take cisapride, erythromycin, pimozide, or quinidine.

To make sure fluconazole is safe for you, tell your doctor if you have:

  • liver disease;

  • HIV or AIDS;

  • cancer;

  • heart disease or heart rhythm disorder;

  • a personal or family history of Long QT syndrome;

  • kidney disease; or

  • if you are allergic to other antifungal medicine (such as ketoconazole, itraconazole, miconazole, posaconazole, voriconazole, and others).

The liquid form of fluconazole contains sucrose. Talk to your doctor before using this form of fluconazole if you have a problem digesting sugars or milk.

A single dose of fluconazole taken to treat a vaginal yeast infection is not expected to harm an unborn baby.

FDA pregnancy category D. Do not take more than 1 dose of fluconazole if you are pregnant. Long-term use of high doses fluconazole can harm an unborn baby or cause birth defects. Tell your doctor if you become pregnant during treatment.

Fluconazole can make birth control pills less effective. Ask your doctor about using non hormonal birth control (condom, diaphragm with spermicide) to prevent pregnancy while taking fluconazole for more than 1 dose.

Fluconazole can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take fluconazole?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Your dose will depend on the infection you are treating. Vaginal infections are often treated with only one pill. For other infections, your first dose may be a double dose. Carefully follow your doctor's instructions.

You may take fluconazole with or without food.

Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Fluconazole will not treat a viral infection such as the flu or a common cold.

Call your doctor if your symptoms do not improve, or if they get worse while using fluconazole.

Store the tablets at room temperature away from moisture and heat.

You may store liquid fluconazole in a refrigerator, but do not allow it to freeze. Throw away any leftover liquid medicine that is more than 2 weeks old.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include confusion or unusual thoughts or behavior.

What should I avoid while taking fluconazole?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Fluconazole side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;

  • fever, chills, body aches, flu symptoms;

  • easy bruising or bleeding, unusual weakness;

  • seizure (convulsions);

  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • skin rash or skin lesions; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • stomach pain, diarrhea, upset stomach;

  • headache;

  • dizziness; or

  • changes in your sense of taste.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Fluconazole dosing information

Usual Adult Dose for Vaginal Candidiasis:

150 mg orally as a single dose

Infectious Diseases Society of America (IDSA) Recommendations:
-Uncomplicated vaginitis: 150 mg orally as a single dose
-Management of recurrent vulvovaginal candidiasis (after 10 to 14 days induction therapy): 150 mg orally once a week for 6 months
-Complicated vulvovaginal candidiasis: 150 mg orally every 72 hours for 3 doses

US CDC Recommendations:
-Uncomplicated vulvovaginal candidiasis: 150 mg orally as a single dose
-Initial therapy for recurrent vulvovaginal candidiasis: 100 to 200 mg orally every 72 hours for 3 doses
-Maintenance therapy for recurrent vulvovaginal candidiasis: 100 to 200 mg orally once a week for 6 months
-Severe vulvovaginal candidiasis: 150 mg orally every 72 hours for 2 doses

US CDC, National Institutes of Health (NIH), and IDSA Recommendations for HIV-infected Patients:
-Uncomplicated vulvovaginal candidiasis: 150 mg orally as a single dose
-Severe or recurrent vulvovaginal candidiasis: 100 to 200 mg orally once a day for at least 7 days
-Suppressive therapy for vulvovaginal candidiasis: 150 mg orally once a week

Comments:
-Recommended as preferred therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Adult Dose for Oral Thrush:

Oropharyngeal candidiasis: 200 mg IV or orally on the first day followed by 100 mg IV or orally once a day
Duration of therapy: At least 2 weeks, to reduce the risk of relapse

IDSA Recommendations:
-Moderate to severe oropharyngeal candidiasis: 100 to 200 mg IV or orally once a day for 7 to 14 days

Comments:
-Recommended as primary therapy

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Initial episodes of oropharyngeal candidiasis: 100 mg orally once a day for 7 to 14 days
-Suppressive therapy for oropharyngeal candidiasis: 100 mg orally once a day or 3 times a week

Comments:
-Recommended as preferred oral therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Adult Dose for Candidemia:

Doses up to 400 mg/day have been used.

Comments:
-Optimal therapeutic dose and therapy duration have not been established.

Use: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia

IDSA Recommendations:
Candidemia in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 400 mg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 400 mg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 400 to 800 mg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, implantable cardioverter defibrillator (ICD), or ventricular assist device (VAD): 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is often appropriate.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

Usual Adult Dose for Fungal Pneumonia:

Doses up to 400 mg/day have been used.

Comments:
-Optimal therapeutic dose and therapy duration have not been established.

Use: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia

IDSA Recommendations:
Candidemia in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 400 mg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 400 mg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 400 to 800 mg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, implantable cardioverter defibrillator (ICD), or ventricular assist device (VAD): 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is often appropriate.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

Usual Adult Dose for Fungal Infection -- Disseminated:

Doses up to 400 mg/day have been used.

Comments:
-Optimal therapeutic dose and therapy duration have not been established.

Use: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia

IDSA Recommendations:
Candidemia in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 400 mg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 400 mg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 400 to 800 mg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, implantable cardioverter defibrillator (ICD), or ventricular assist device (VAD): 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is often appropriate.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

Usual Adult Dose for Systemic Candidiasis:

Doses up to 400 mg/day have been used.

Comments:
-Optimal therapeutic dose and therapy duration have not been established.

Use: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia

IDSA Recommendations:
Candidemia in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 400 mg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 400 mg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 400 to 800 mg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, implantable cardioverter defibrillator (ICD), or ventricular assist device (VAD): 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is often appropriate.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

Usual Adult Dose for Esophageal Candidiasis:

200 mg IV or orally on the first day followed by 100 mg IV or orally once a day
Duration of therapy: At least 3 weeks and for at least 2 weeks after symptoms resolve

Comments:
-Doses up to 400 mg/day may be used based on clinical judgment of patient response.

IDSA Recommendations: 200 to 400 mg IV or orally once a day for 14 to 21 days

Comments:
-Recommended as primary therapy; oral fluconazole is preferred.

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients: 100 to 400 mg IV or orally once a day for 14 to 21 days
-Suppressive therapy: 100 to 200 mg orally once a day

Comments:
-Recommended as preferred therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Adult Dose for Candida Urinary Tract Infection:

50 to 200 mg IV or orally once a day

Use: For the treatment of Candida urinary tract infections and peritonitis

IDSA Recommendations:
-Asymptomatic cystitis in patients undergoing urologic procedures: 200 to 400 mg IV or orally once a day for several days before and after the procedure
-Symptomatic cystitis: 200 mg IV or orally once a day for 2 weeks
-Pyelonephritis: 200 to 400 mg IV or orally once a day for 2 weeks
-Urinary fungus balls: 200 to 400 mg IV or orally once a day until symptoms resolve and urine cultures clear of Candida

Comments:
-Recommended as primary therapy
-The suggested dose for candidemia is recommended for patients with pyelonephritis and suspected disseminated candidiasis.
-Surgical removal of urinary fungus balls strongly recommended.

Usual Adult Dose for Fungal Peritonitis:

50 to 200 mg IV or orally once a day

Use: For the treatment of Candida urinary tract infections and peritonitis

IDSA Recommendations:
-Asymptomatic cystitis in patients undergoing urologic procedures: 200 to 400 mg IV or orally once a day for several days before and after the procedure
-Symptomatic cystitis: 200 mg IV or orally once a day for 2 weeks
-Pyelonephritis: 200 to 400 mg IV or orally once a day for 2 weeks
-Urinary fungus balls: 200 to 400 mg IV or orally once a day until symptoms resolve and urine cultures clear of Candida

Comments:
-Recommended as primary therapy
-The suggested dose for candidemia is recommended for patients with pyelonephritis and suspected disseminated candidiasis.
-Surgical removal of urinary fungus balls strongly recommended.

Usual Adult Dose for Cryptococcal Meningitis -- Immunocompetent Host:

Acute infection: 400 mg IV or orally on the first day followed by 200 mg IV or orally once a day
Duration of therapy: 10 to 12 weeks after CSF culture is negative

Comments:
-Dose of 400 mg IV or orally once a day may be used based on clinical judgment of patient response.

IDSA Recommendations:
-Consolidation therapy (after induction therapy): 400 to 800 mg orally once a day for 8 weeks
-Maintenance therapy: 200 mg orally once a day for 6 to 12 months

Comments:
-Preferred agent
-The higher dose (800 mg/day) is recommended for consolidation therapy if the 2-week induction regimen was used.
-Maintenance therapy is recommended to prevent relapse.

Cerebral cryptococcoma:
-Consolidation and maintenance therapy (after induction therapy): 400 to 800 mg orally once a day for 6 to 18 months

Usual Adult Dose for Cryptococcal Meningitis -- Immunosuppressed Host:

Acute infection: 400 mg IV or orally on the first day followed by 200 mg IV or orally once a day
Duration of therapy: 10 to 12 weeks after CSF culture is negative

Comments:
-Dose of 400 mg IV or orally once a day may be used based on clinical judgment of patient response.

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

IDSA Recommendations:
HIV-infected patients:
-Induction therapy: 800 to 2000 mg orally once a day for 6 to 12 weeks, depending on regimen
-Consolidation therapy (after induction therapy): 400 mg orally once a day for at least 8 weeks
-Maintenance (suppressive) and prophylactic therapy: 200 mg orally once a day for at least 12 months

Comments:
-Recommended as an alternative for induction therapy; use is not encouraged.
-Preferred agent for consolidation therapy and maintenance and prophylactic therapy

Organ transplant recipients:
-Consolidation therapy (after induction therapy): 400 to 800 mg orally once a day for 8 weeks
-Maintenance therapy: 200 to 400 mg orally once a day for 6 to 12 months

Comments:
-Preferred agent

Cerebral cryptococcoma:
-Consolidation and maintenance therapy (after induction therapy): 400 to 800 mg orally once a day for 6 to 18 months

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Induction therapy: 400 to 1200 mg IV or orally once a day for at least 2 weeks
-Consolidation therapy (after at least 2 weeks successful induction therapy): 400 mg IV or orally once a day for at least 8 weeks
-Maintenance therapy: 200 mg orally once a day for at least 1 year

Comments:
-Recommended for use in alternative regimens for induction therapy; dose depends on regimen (i.e., used with amphotericin B, flucytosine, or alone).
-Recommended as preferred regimen for consolidation therapy; should be followed by maintenance therapy
-Recommended as preferred regimen for maintenance therapy

Usual Adult Dose for Cryptococcosis:

IDSA Recommendations:
Mild to moderate pulmonary infection and nonmeningeal, nonpulmonary infection if CNS disease ruled out, no fungemia, single site of infection, no immunosuppressive risk factors: 400 mg orally once a day for 6 to 12 months

Severe pulmonary infection and nonmeningeal, nonpulmonary infection with cryptococcemia:
-Consolidation therapy (after induction therapy): 400 to 800 mg orally once a day for at least 8 weeks
-Maintenance therapy: 200 to 400 mg orally once a day for 12 months

Comments:
-Preferred agent
-Maintenance therapy is recommended to prevent relapse.
-Primary prophylaxis not routinely recommended.

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
Non-CNS cryptococcosis with mild to moderate symptoms and focal pulmonary infiltrates: 400 mg orally once a day for 12 months

Non-CNS, extrapulmonary cryptococcosis and diffuse pulmonary disease:
-Induction therapy: 400 to 1200 mg IV or orally once a day for at least 2 weeks
-Consolidation therapy (after at least 2 weeks successful induction therapy): 400 mg IV or orally once a day for at least 8 weeks
-Maintenance therapy: 200 mg orally once a day for at least 1 year

Comments:
-Recommended for use in alternative regimens for induction therapy; dose depends on regimen (i.e., used with amphotericin B, flucytosine, or alone).
-Recommended as preferred regimen for consolidation therapy; should be followed by maintenance therapy
-Recommended as preferred regimen for maintenance therapy

Usual Adult Dose for Fungal Infection Prophylaxis:

400 mg IV or orally once a day
Duration of therapy: 7 days after neutrophil count rises above 1000 cells/mm3

Comments:
-If severe granulocytopenia (less than 500 neutrophils/mm3) is expected, prophylaxis should start several days before the likely onset of neutropenia.

Use: For prophylaxis to reduce the incidence of candidiasis in bone marrow transplantation recipients who receive cytotoxic chemotherapy and/or radiation therapy

IDSA Recommendations:
Empiric therapy for suspected candidiasis in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: Uncertain; should discontinue if cultures and/or serodiagnostic test results negative

Comments:
-Suspected candidiasis in nonneutropenic patients: Recommended as primary therapy; an echinocandin is preferred for moderately severe to severe illness or recent azole exposure; patient selection should be based on clinical risk factors, serologic tests, and culture data.
-Suspected candidiasis in neutropenic patients: Recommended as alternative therapy; should start empiric therapy after 4 days persistent fever despite antibiotics; serodiagnostic and computed tomography (CT) imaging may help; should not use in patients with prior azole prophylaxis.

Usual Adult Dose for Coccidioidomycosis -- Meningitis:

IDSA Recommendations: 400 mg orally once a day

Comments:
-Some experts start therapy with 800 to 1000 mg/day.
-Patients who respond to therapy should continue this treatment indefinitely.

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Meningeal infection: 400 to 800 mg IV or orally once a day
-Chronic suppressive therapy: 400 mg orally once a day

Comments:
-Recommended as preferred therapy for meningeal infection and chronic suppressive therapy
-A specialist should be consulted for meningeal infections.
-Since relapse is common (80%), suppressive therapy should be lifelong.

Usual Adult Dose for Coccidioidomycosis:

IDSA Recommendations: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Uncomplicated coccidioidal pneumonia: 3 to 6 months
-Diffuse pneumonia and chronic progressive fibrocavitary pneumonia: At least 1 year

Comments:
-Therapy for diffuse pneumonia is usually started with high-dose fluconazole; if therapy started with IV amphotericin B (e.g., if significant hypoxia or rapid deterioration), may switch to oral azole antifungal therapy after evident improvement; total duration of therapy should be at least 1 year; oral azole therapy should continue as secondary prophylaxis in severely immunodeficient patients.
-Initial therapy with oral azole antifungals is recommended for chronic progressive fibrocavitary pneumonia.
-Initial therapy for nonmeningeal disseminated infection (extrapulmonary) is generally started with oral azole antifungals, most often fluconazole or itraconazole; clinical trials used 400 mg/day; some experts recommend up to 2 g/day of fluconazole.

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Primary prophylaxis: 400 mg orally once a day
-Mild infections (e.g., focal pneumonia): 400 mg orally once a day
-Severe nonmeningeal infection (diffuse pulmonary or severely ill patients with extrathoracic disseminated disease) - acute phase: 400 mg IV or orally once a day
-Chronic suppressive therapy (secondary prophylaxis): 400 mg orally once a day

Comments:
-Recommended as preferred therapy for mild infection and chronic suppressive therapy
-Recommended as alternative therapy for severe nonmeningeal infection; some experts add a triazole to amphotericin B (preferred therapy) and continue the triazole after amphotericin B is stopped.

Usual Adult Dose for Histoplasmosis:

IDSA Recommendations:
-Disseminated infections in patients without AIDS: 200 to 800 mg IV or orally once a day for at least 12 months
-CNS infection (after initial regimen of IV amphotericin B): 200 to 400 mg IV or orally once a day for 12 months

Comments:
-Recommended as alternative therapy in patients unable to use itraconazole

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Less severe disseminated infection: 800 mg orally once a day for at least 12 months
-Long-term suppressive therapy (secondary prophylaxis): 400 mg orally once a day for more than 1 year

Comments:
-Recommended as alternative therapy
-This drug should only be used for treatment of less severe disseminated infection in moderately ill patients intolerant of itraconazole.

Usual Adult Dose for Blastomycosis:

IDSA Recommendations:
-Mild to moderate pulmonary infection or mild to moderate disseminated infection without CNS involvement: 400 to 800 mg orally once a day for at least 6 to 12 months
-CNS infection (after initial regimen of IV amphotericin B): 800 mg orally once a day for at least 12 months and until CSF abnormalities resolve

Comments:
-Recommended as alternative therapy for mild to moderate pulmonary infection or mild to moderate disseminated infection without CNS involvement
-Recommended as follow-up therapy for CNS infection

Usual Adult Dose for Onychomycosis -- Fingernail:

Some experts recommend: 150 to 300 mg orally once a week
Duration of therapy:
-Fingernail infections: 3 to 6 months
-Toenail infections: 6 to 12 months

Usual Adult Dose for Onychomycosis -- Toenail:

Some experts recommend: 150 to 300 mg orally once a week
Duration of therapy:
-Fingernail infections: 3 to 6 months
-Toenail infections: 6 to 12 months

Usual Adult Dose for Sporotrichosis:

IDSA Recommendations:
Cutaneous or lymphocutaneous infection: 400 to 800 mg IV or orally once a day
Duration of therapy: 2 to 4 weeks after all lesions resolve (usually 3 to 6 months total)

Comments:
-Recommended as alternative therapy; should only be used if other agents are not tolerated

Usual Pediatric Dose for Esophageal Candidiasis:

2 weeks or younger (gestational age 26 to 29 weeks): 3 mg/kg IV or orally every 72 hours
Older than 2 weeks: 6 mg/kg IV or orally on the first day followed by 3 mg/kg IV or orally once a day
Duration of therapy: At least 3 weeks and for at least 2 weeks after symptoms resolve

Comments:
-Doses up to 12 mg/kg/day may be used in patients older than 2 weeks based on clinical judgment of patient response; this correlates to 12 mg/kg/72 hours in premature newborns during their first 2 weeks of life.

IDSA Recommendations: 3 to 6 mg/kg IV or orally once a day for 14 to 21 days

Comments:
-Recommended as primary therapy; oral fluconazole is preferred.

US CDC, NIH, IDSA, Pediatric Infectious Diseases Society (PIDS), and American Academy of Pediatrics (AAP) Recommendations for HIV-exposed and HIV-infected Children: 6 to 12 mg/kg IV or orally once a day
Maximum dose: 600 mg/dose
Duration of therapy: At least 3 weeks and for at least 2 weeks after symptoms resolve

Comments:
-Oral fluconazole recommended as preferred therapy; IV dosing recommended as alternative therapy for infants and children of all ages.
-If neonate creatinine level is greater than 1.2 mg/dL for 3 consecutive doses, the dosing interval for the higher dose may be extended to 12 mg/kg every 48 hours until serum creatinine level is less than 1.2 mg/dL.

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents: 100 to 400 mg IV or orally once a day for 14 to 21 days
-Suppressive therapy: 100 to 200 mg orally once a day

Comments:
-Recommended as preferred therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Pediatric Dose for Oral Thrush:

Oropharyngeal candidiasis:
2 weeks or younger (gestational age 26 to 29 weeks): 3 mg/kg IV or orally every 72 hours
Older than 2 weeks: 6 mg/kg IV or orally on the first day followed by 3 mg/kg IV or orally once a day
Duration of therapy: At least 2 weeks, to reduce the risk of relapse

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children: 6 to 12 mg/kg orally once a day
Maximum dose: 400 mg/dose
Duration of therapy: 7 to 14 days

Comments:
-Recommended as preferred therapy; oral fluconazole recommended for moderate or severe oropharyngeal candidiasis.

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Initial episodes: 100 mg orally once a day for 7 to 14 days
-Suppressive therapy: 100 mg orally once a day or 3 times a week

Comments:
-Recommended as preferred oral therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Pediatric Dose for Candidemia:

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

Use: For the treatment of candidemia and disseminated Candida infections

IDSA Recommendations:
Neonatal candidiasis: 12 mg/kg IV or orally once a day for at least 3 weeks

Candidemia in nonneutropenic or neutropenic patients: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 6 mg/kg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 6 mg/kg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 6 to 12 mg/kg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 6 to 12 mg/kg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, ICD, or VAD: 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Recommended as primary therapy for neonatal candidiasis
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is appropriate in many cases.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Invasive disease in infants and children (all ages): 12 mg/kg IV once a day
Maximum dose: 600 mg/dose
Duration of therapy: Based on presence of deep-tissue foci and clinical response
-Uncomplicated candidemia: At least 2 weeks after last positive blood culture

Secondary prophylaxis: 3 to 6 mg/kg IV or orally once a day
Maximum dose: 200 mg/dose

Comments:
-Recommended as alternative therapy in critically ill patients with invasive disease
-Recommended as preferred therapy in patients with invasive disease who are not critically ill; this drug should be avoided for Candida krusei and C glabrata.
-Secondary prophylaxis may be considered for frequent or severe recurrences of candidiasis; not routinely recommended.

Usual Pediatric Dose for Fungal Infection -- Disseminated:

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

Use: For the treatment of candidemia and disseminated Candida infections

IDSA Recommendations:
Neonatal candidiasis: 12 mg/kg IV or orally once a day for at least 3 weeks

Candidemia in nonneutropenic or neutropenic patients: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 6 mg/kg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 6 mg/kg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 6 to 12 mg/kg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 6 to 12 mg/kg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, ICD, or VAD: 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Recommended as primary therapy for neonatal candidiasis
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is appropriate in many cases.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Invasive disease in infants and children (all ages): 12 mg/kg IV once a day
Maximum dose: 600 mg/dose
Duration of therapy: Based on presence of deep-tissue foci and clinical response
-Uncomplicated candidemia: At least 2 weeks after last positive blood culture

Secondary prophylaxis: 3 to 6 mg/kg IV or orally once a day
Maximum dose: 200 mg/dose

Comments:
-Recommended as alternative therapy in critically ill patients with invasive disease
-Recommended as preferred therapy in patients with invasive disease who are not critically ill; this drug should be avoided for Candida krusei and C glabrata.
-Secondary prophylaxis may be considered for frequent or severe recurrences of candidiasis; not routinely recommended.

Usual Pediatric Dose for Systemic Candidiasis:

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

Use: For the treatment of candidemia and disseminated Candida infections

IDSA Recommendations:
Neonatal candidiasis: 12 mg/kg IV or orally once a day for at least 3 weeks

Candidemia in nonneutropenic or neutropenic patients: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 6 mg/kg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 6 mg/kg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 6 to 12 mg/kg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 6 to 12 mg/kg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, ICD, or VAD: 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Recommended as primary therapy for neonatal candidiasis
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is appropriate in many cases.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Invasive disease in infants and children (all ages): 12 mg/kg IV once a day
Maximum dose: 600 mg/dose
Duration of therapy: Based on presence of deep-tissue foci and clinical response
-Uncomplicated candidemia: At least 2 weeks after last positive blood culture

Secondary prophylaxis: 3 to 6 mg/kg IV or orally once a day
Maximum dose: 200 mg/dose

Comments:
-Recommended as alternative therapy in critically ill patients with invasive disease
-Recommended as preferred therapy in patients with invasive disease who are not critically ill; this drug should be avoided for Candida krusei and C glabrata.
-Secondary prophylaxis may be considered for frequent or severe recurrences of candidiasis; not routinely recommended.

Usual Pediatric Dose for Cryptococcal Meningitis -- Immunocompetent Host:

Acute infection:
2 weeks or younger (gestational age 26 to 29 weeks): 6 mg/kg IV or orally every 72 hours
Older than 2 weeks: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy: 10 to 12 weeks after CSF culture is negative

Comments:
-Dose of 12 mg/kg IV or orally once a day may be used in patients older than 2 weeks based on clinical judgment of patient response; this correlates to 12 mg/kg IV or orally every 72 hours in premature newborns during their first 2 weeks of life.

IDSA Recommendations:
CNS infection in children:
-Consolidation therapy (after induction therapy): 10 to 12 mg/kg orally once a day for 8 weeks
-Maintenance therapy: 6 mg/kg orally once a day

Comments:
-Preferred agent
-Maintenance therapy is recommended to prevent relapse.

Usual Pediatric Dose for Cryptococcal Meningitis -- Immunosuppressed Host:

Acute infection:
2 weeks or younger (gestational age 26 to 29 weeks): 6 mg/kg IV or orally every 72 hours
Older than 2 weeks: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy: 10 to 12 weeks after CSF culture is negative

Comments:
-Dose of 12 mg/kg IV or orally once a day may be used in patients older than 2 weeks based on clinical judgment of patient response; this correlates to 12 mg/kg IV or orally every 72 hours in premature newborns during their first 2 weeks of life.

Suppression of relapse in children with AIDS: 6 mg/kg IV or orally once a day

IDSA Recommendations for children:
CNS disease:
-Consolidation therapy (after induction therapy): 10 to 12 mg/kg/day orally in 2 divided doses for 8 weeks
-Maintenance therapy in HIV-infected patients: 6 mg/kg orally once a day

Comments:
-Preferred agent
-Maintenance therapy is recommended to prevent relapse.

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Acute therapy (induction): 12 mg/kg IV or orally on the first day followed by 10 to 12 mg/kg IV or orally once a day
Maximum dose: 800 mg/dose
Duration of therapy: At least 2 weeks

Consolidation therapy: 12 mg/kg IV or orally on the first day followed by 10 to 12 mg/kg IV or orally once a day
Maximum dose: 800 mg/dose
Duration of therapy: At least 8 weeks

Secondary prophylaxis: 6 mg/kg orally once a day
Maximum dose: 200 mg/dose
Duration of therapy: At least 1 year

Comments:
-Recommended in alternative regimens for acute therapy if flucytosine not tolerated or unavailable or amphotericin B-based therapy not tolerated
-Recommended as preferred agent for consolidation therapy; should be followed by secondary prophylaxis
-Recommended as preferred therapy for secondary prophylaxis

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Induction therapy: 400 to 1200 mg IV or orally once a day for at least 2 weeks
-Consolidation therapy (after at least 2 weeks successful induction therapy): 400 mg IV or orally once a day for at least 8 weeks
-Maintenance therapy: 200 mg orally once a day for at least 1 year

Comments:
-Recommended for use in alternative regimens for induction therapy; dose depends on regimen (i.e., used with amphotericin B, flucytosine, or alone).
-Recommended as preferred regimen for consolidation therapy; should be followed by maintenance therapy
-Recommended as preferred regimen for maintenance therapy

Usual Pediatric Dose for Cryptococcosis:

IDSA Recommendations for children:
Disseminated disease:
-Consolidation therapy (after induction therapy): 10 to 12 mg/kg/day orally in 2 divided doses for 8 weeks
-Maintenance therapy in HIV-infected patients: 6 mg/kg orally once a day

Cryptococcal pneumonia: 6 to 12 mg/kg orally once a day for 6 to 12 months

Comments:
-Preferred agent
-Maintenance therapy is recommended to prevent relapse.

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Localized disease (including isolated pulmonary disease [non-CNS]), disseminated disease (non-CNS), or severe pulmonary disease: 12 mg/kg IV or orally on the first day followed by 6 to 12 mg/kg IV or orally once a day
Maximum dose: 600 mg/dose
Duration of therapy: Based on site and severity of infection and clinical response

Secondary prophylaxis: 6 mg/kg orally once a day
Maximum dose: 200 mg/dose
Duration of therapy: At least 1 year

Comments:
-Recommended as preferred therapy for localized disease and secondary prophylaxis
-Recommended as alternative therapy for disseminated disease and severe pulmonary disease

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
Non-CNS cryptococcosis with mild to moderate symptoms and focal pulmonary infiltrates: 400 mg orally once a day for 12 months

Non-CNS, extrapulmonary cryptococcosis and diffuse pulmonary disease:
-Induction therapy: 400 to 1200 mg IV or orally once a day for at least 2 weeks
-Consolidation therapy (after at least 2 weeks successful induction therapy): 400 mg IV or orally once a day for at least 8 weeks
-Maintenance therapy: 200 mg orally once a day for at least 1 year

Comments:
-Recommended for use in alternative regimens for induction therapy; dose depends on regimen (i.e., used with amphotericin B, flucytosine, or alone).
-Recommended as preferred regimen for consolidation therapy; should be followed by maintenance therapy
-Recommended as preferred regimen for maintenance therapy

Usual Pediatric Dose for Fungal Infection Prophylaxis:

IDSA Recommendations:
Empiric therapy for suspected candidiasis in nonneutropenic or neutropenic patients: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: Uncertain; should discontinue if cultures and/or serodiagnostic test results negative

Comments:
-Suspected candidiasis in nonneutropenic patients: Recommended as primary therapy; an echinocandin is preferred for moderately severe to severe illness or recent azole exposure; patient selection should be based on clinical risk factors, serologic tests, and culture data.
-Suspected candidiasis in neutropenic patients: Recommended as alternative therapy; should start empiric therapy after 4 days persistent fever despite antibiotics; serodiagnostic and CT imaging may help; should not use in patients with prior azole prophylaxis.

Usual Pediatric Dose for Candida Urinary Tract Infection:

IDSA Recommendations:
-Asymptomatic cystitis in patients undergoing urologic procedures: 3 to 6 mg/kg IV or orally once a day for several days before and after the procedure
-Symptomatic cystitis: 3 mg/kg IV or orally once a day for 2 weeks
-Pyelonephritis: 3 to 6 mg/kg IV or orally once a day for 2 weeks
-Urinary fungus balls: 3 to 6 mg/kg IV or orally once a day until symptoms resolve and urine cultures clear of Candida

Comments:
-Recommended as primary therapy
-The suggested dose for candidemia is recommended for patients with pyelonephritis and suspected disseminated candidiasis.
-Surgical removal of urinary fungus balls strongly recommended in non-neonates.

Usual Pediatric Dose for Coccidioidomycosis -- Meningitis:

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Meningeal infection: 12 mg/kg IV or orally once a day
Maximum dose: 800 mg/dose

Secondary prophylaxis: 6 mg/kg orally once a day
Maximum dose: 400 mg/dose
Duration of therapy: Lifelong

Comments:
-Recommended as preferred therapy
-Secondary prophylaxis should follow treatment of meningeal infection.

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Meningeal infection: 400 to 800 mg IV or orally once a day
-Chronic suppressive therapy: 400 mg orally once a day

Comments:
-Recommended as preferred therapy for meningeal infection and chronic suppressive therapy
-A specialist should be consulted for meningeal infections.
-Since relapse is common (80%), suppressive therapy should be lifelong.

Usual Pediatric Dose for Coccidioidomycosis:

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Severe illness with respiratory compromise due to diffuse pulmonary or disseminated nonmeningeal infection: 12 mg/kg IV or orally once a day
Maximum dose: 800 mg/dose
Duration of therapy: 1 year total

Mild to moderate nonmeningeal infection (e.g., focal pneumonia): 6 to 12 mg/kg IV or orally once a day
Maximum dose: 400 mg/dose

Secondary prophylaxis: 6 mg/kg orally once a day
Maximum dose: 400 mg/dose
Duration of therapy: Lifelong in patients with disseminated disease

Comments:
-Recommended as alternative therapy for severe illness with respiratory compromise due to diffuse pulmonary or disseminated nonmeningeal infection; should be followed by secondary prophylaxis
-After patient with severe illness with respiratory compromise due to diffuse pulmonary or disseminated nonmeningeal infection is stabilized using the preferred regimen, may switch to fluconazole to complete therapy (total duration: 1 year)
-Recommended as preferred therapy for secondary prophylaxis; usually recommended after initial induction therapy for disseminated disease; may also be used after milder disease

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Primary prophylaxis: 400 mg orally once a day
-Mild infections (e.g., focal pneumonia): 400 mg orally once a day
-Severe nonmeningeal infection (diffuse pulmonary or severely ill patients with extrathoracic disseminated disease) - acute phase: 400 mg IV or orally once a day
-Chronic suppressive therapy (secondary prophylaxis): 400 mg orally once a day

Comments:
-Recommended as preferred therapy for mild infection and chronic suppressive therapy
-Recommended as alternative therapy for severe nonmeningeal infection; some experts add a triazole to amphotericin B (preferred therapy) and continue the triazole after amphotericin B is stopped.

Usual Pediatric Dose for Vaginal Candidiasis:

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Uncomplicated vulvovaginal candidiasis: 150 mg orally as a single dose
-Severe or recurrent vulvovaginal candidiasis: 100 to 200 mg orally once a day for at least 7 days
-Suppressive therapy for vulvovaginal candidiasis: 150 mg orally once a week

Comments:
-Recommended as preferred therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Pediatric Dose for Histoplasmosis:

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Acute primary pulmonary infection: 3 to 6 mg/kg orally once a day
Maximum dose: 200 mg/dose

Mild disseminated disease: 5 to 6 mg/kg IV or orally twice a day
Maximum dose: 300 mg/dose
Duration of therapy: 12 months

Secondary prophylaxis: 3 to 6 mg/kg orally once a day
Maximum dose: 200 mg/dose

Comments:
-Recommended as alternative therapy

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Less severe disseminated infection: 800 mg orally once a day for at least 12 months
-Long-term suppressive therapy (secondary prophylaxis): 400 mg orally once a day for more than 1 year

Comments:
-Recommended as alternative therapy
-This drug should only be used for treatment of less severe disseminated infection in moderately ill patients intolerant of itraconazole.

What other drugs will affect fluconazole?

Certain other drugs can cause unwanted or dangerous effects when used with fluconazole. Your doctor may need to change your treatment plan if you use any of the following drugs:

  • halofantrine;

  • prednisone;

  • theophylline;

  • tofacitinib;

  • vitamin A;

  • an antidepressant--amitriptyline, nortriptyline;

  • other antifungal medicine--amphotericin B or voriconazole;

  • blood pressure medicine--hydrochlorothiazide (HCTZ), losartan, amlodipine, nifedipine, felodipine;

  • a blood thinner (warfarin, Coumadin, Jantoven);

  • cancer medicine--cyclophosphamide, vincristine, vinblastine;

  • cholesterol medicine--atorvastatin, simvastatin, fluvastatin;

  • HIV/AIDS medicine--saquinavir, zidovudine, and others;

  • medicine to prevent organ transplant rejection--cyclosporine, tacrolimus or sirolimus;

  • narcotic medicine--fentanyl, alfentanil, methadone;

  • NSAIDs (nonsteroidal anti-inflammatory drugs)--celecoxib, ibuprofen, naproxen;

  • oral diabetes medicine--glyburide, tolbutamide, glipizide;

  • seizure medicine--carbamazepine, phenytoin; or

  • tuberculosis medication--rifampin, rifabutin.

This list is not complete and many other drugs can interact with fluconazole. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all your medications and any you start or stop using during treatment with fluconazole. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about fluconazole.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 9.01. Revision Date: 2014-04-16, 9:08:56 AM.

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