Oral: Oropharyngeal candidiasis: 200mg orally x 1, followed by
100mg orally once daily. Esophageal candidiasis: 100-200 mg orally once daily
(up to 400mg/day). Cryptococcal meningitis: 400mg orally x 1, followed by 200mg
orally once daily x 10-12 weeks (Suppression: 50-200mg orally once daily).
Onychomycosis: 200-300mg once weekly or 100-200mg orally every other day
(further studies needed).
DOSAGE AND ADMINISTRATION
Dosage and Administration in Adults:
SINCE ORAL ABSORPTION IS RAPID AND ALMOST COMPLETE, THE DAILY DOSE OF
FLUCONAZOLE IS THE SAME FOR ORAL (TABLETS AND SUSPENSION) AND INTRAVENOUS
ADMINISTRATION. 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.
The daily dose of fluconazole for the treatment of infections other than vaginal
candidiasis 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 that active fungal infection has subsided. An
inadequate period of treatment may lead to recurrence of active infection.
Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal
candidiasis usually require maintenance therapy to prevent relapse.
Oropharyngeal candidiasis: The recommended dosage of
fluconazole for oropharyngeal candidiasis is 200 mg on the first day, followed
by 100 mg once daily. Clinical evidence of oropharyngeal candidiasis generally
resolves within several days, but treatment should be continued for at least 2
weeks to decrease the likelihood of relapse.
Esophageal candidiasis: The recommended dosage of fluconazole
for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once
daily. Doses up to 400 mg/day may be used, based on medical judgment of the
patient’s response to therapy. Patients with esophageal candidiasis should be
treated for a minimum of three weeks and for at least two weeks following
resolution of symptoms.
Systemic Candida infections: For systemic Candida infections
including candidemia, disseminated candidiasis, and pneumonia, optimal
therapeutic dosage and duration of therapy have not been established. In open,
noncomparative studies of small numbers of patients, doses of up to 400 mg daily
have been used.
Urinary tract infections and peritonitis: For the treatment of
Candida urinary tract infections and peritonitis, daily doses of 50 to 200 mg
have been used in open, noncomparative studies of small numbers of patients.
Cryptococcal meningitis: The recommended dosage for treatment
of acute cryptococcal meningitis is 400 mg on the first day, followed by 200 mg
once daily. A dosage of 400 mg once daily may be used, based on medical judgment
of the patient’s response to therapy. The recommended duration of treatment for
initial therapy of cryptococcal meningitis is 10 to 12 weeks after the
cerebrospinal fluid becomes culture negative. The recommended dosage of
fluconazole for suppression of relapse of cryptococcal meningitis in patients
with AIDS is 200 mg once daily.
Prophylaxis in patients undergoing bone marrow transplantation:
The recommended fluconazole daily dosage for the prevention of candidiasis of
patients undergoing bone marrow transplantation is 400 mg, once daily. Patients
who are anticipated to have severe granulocytopenia (less than 500 neutrophils
per cu mm) should start fluconazole prophylaxis several days before the
anticipated onset of neutropenia, and continue for 7 days after the neutrophil
count rises above 1,000 cells per cu mm.
Dosage In Patients With Impaired Renal
Fluconazole is cleared primarily by renal excretion as unchanged drug.
In patients with impaired renal function who will receive multiple doses
of fluconazole, an initial loading dose of 50 to 400 mg should be given.
After the loading dose, the daily dose (according to indication) should
be based on the following table:
Creatinine Clearance (mL/min)
Percent of Recommended Dose
after each dialysis
These are suggested dose adjustments based on pharmacokinetics following
administration of multiple doses. Further adjustment may be needed
depending upon clinical condition.
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical
judgment. Neither GlobalRPh Inc. nor any other party involved in the
preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER
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