The daily dose of fluconazole should be based on the nature and severity of the fungal infection. Most cases of vaginal candidiasis respond to single-dose therapy. Therapy for those types of infections requiring multiple-dose 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.
Use in Adults: For Cryptococcal Meningitis and Cryptococcal Infections at Other Sites:
Usual Dose: 400 mg on the 1st day followed by 200-400 mg once daily. Duration of treatment for cryptococcal infections will depend on the clinical and mycological response, but is usually at least 6-8 weeks for cryptococcal meningitis.
Prevention of Relapse of Cryptococcal Meningitis in Patients with AIDS:
After the patient receives a full course of primary therapy, fluconazole may be administered indefinitely at a daily dose of 200 mg.
For candidemia, disseminated candidiasis and other invasive candidal infections the usual dose is 400 mg on the 1st day followed by 200 mg daily. Depending on the clinical response, the dose may be increased to 400 mg daily. Duration of treatment is based upon the clinical response.
For oropharyngeal candidiasis:
usual dose is 50-100 mg once daily for 7-14 days. If necessary, treatment can be continued for longer periods in patients with severely compromised immune function. For atrophic oral candidiasis associated with dentures, the usual dose is 50 mg once daily for 14 days administered concurrently with local antiseptic measures to the denture.
For other candidal infections of the mucosa except genital candidiasis, (e.g., esophagitis, non-invasive bronchopulmonary infections, candiduria, mucocutaneous candidiasis, etc.) the usual effective dose is 50-100 mg daily, given for 14-30 days.
For the prevention of relapse of oropharyngeal candidiasis in patients with AIDS, after the patient receives a full course of primary therapy, fluconazole may be administered at a 150 mg once weekly dose.
For the treatment of vaginal candidiasis, fluconazole 150 mg should be administered as a single oral dose. To reduce the incidence of recurrent vaginal candidiasis, a 150 mg once monthly dose may be used. The duration of therapy should be individualized, but ranges from 4-12 months. Some patients may require a more frequent dosing.
For Candida Balanitis
, fluconazole 150 mg should be administered as a single oral dose.
The recommended fluconazole dosage for the prevention of candidiasis is 50-400 mg once daily, based on the patient's risk for developing fungal infection. For patients at risk of systemic infection eg, patients who are anticipated to have profound or prolonged neutropenia, the recommended daily dose are 400 mg once daily. Fluconazole administration should start several days before the anticipated onset of neutropenia and continue for 7 days after the neutrophil count rises above 1000 cells/mm3
For dermal infections including tinea pedis, corporis, cruris and candida infections the recommended dosage:
150 mg once weekly or 50mg once daily. Duration of treatment is normally 2-4 weeks but tinea pedis may require treatment for up to 6 weeks.
For tinea versicolor, the recommended dose is 300 mg once weekly for 2 weeks; a 3rd weekly dose of 300 mg may be needed in some patients, whereas, in some patients, a single dose of 300-400 mg may be sufficient. An alternate dosing regimen is 50mg once daily for 2-4 weeks.
Use in Children:
As with similar infections in adults, the duration of treatment is based on the clinical and mycological response. The maximum adult daily dosage should not be exceeded in children. Fluconazole is administered as a single dose each day.
The recommended dosage of fluconazole for mucosal candidiasis is 3 mg/kg daily. A loading dose of 6 mg/kg may be used on the 1st day to achieve steady-state levels more rapidly.
For the treatment of systemic candidiasis and cryptococcal infections, the recommended dosage is 6-12 mg/kg daily, depending on the severity of the disease.
For the prevention of fungal infections in immunocompromised patients considered at risk as a consequence of neutropenia following cytotoxic chemotherapy or radiotherapy, the dose should be 3-12 mg/kg daily, depending on the extent and duration of the induced neutropenia (see Use in Adults). (For Children with impaired renal functions, see Use in Renal Impairment).
Use in Children below 4 weeks of age and younger:
Neonates excrete fluconazole slowly. In the first 2 weeks of life, the same mg/kg dosing as in older children should be used but administered every 72 hrs. During weeks 2-4 of life, the same dose should be given every 48 hours.
*Capsule is not recommended for children.
Use in Elderly:
Where there is no evidence of renal impairment, normal dosage recommendations should be adopted. For patients with renal impairment (creatinine clearance <50mL/min) the dosage schedule should be adjusted as described as follows.
Use in Renal Impairment:
Fluconazole is predominantly excreted in the urine as unchanged drug. No adjustments in single-dose therapy are necessary. In patients (including children) with impaired renal function who will receive multiple doses of fluconazole, an initial loading dose of 50-400 mg should be given. After the loading dose, the daily dose (according to indication) should be based on the following table. (See table.)
Click on icon to see table/diagram/image
These are suggested dose adjustments based on pharmacokinetics following administration of single dose. Further adjustment may be needed depending on clinical condition.