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.
Adults: 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 at least 200 mg.
Candidaemia, Disseminated Candidiasis and Other Invasive Candidal Infections:
Usual Dose: 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.
Usual Dose: 50 mg once daily for 7-14 days. If necessary, treatment can be continued for longer periods in patients with severely immune function.
Atrophic Oral Candidiasis Associated with Dentures:
Usual Dose: 50 mg once daily for 14 days administered concurrently with local antiseptic measures to the denture.
For other candidal infections of the mucosa, (except vaginal candidiasis, see following text, eg 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.
Treatment of Vaginal Candidiasis:
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.
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.
Dermal Infections Including Tinea Pedis, Corporis, Cruris and Candida Infections:
Recommended dosage: 150 mg once weekly or 50 mg once daily. Duration of treatment is normally 2-4 weeks but tinea pedis may require treatment for up to 6 weeks.
Recommended Dose: 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 50 mg once daily for 2-4 weeks.
For patients at high risk of systemic infection, eg patients who are anticipated to have profound or prolonged neutropenia, the recommended daily dose is 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
Where there is no evidence of renal impairment, normal dosage recommendations should be adopted. For patients with renal impairment (creatinine clearance <50 mL/min) the dosage schedule should be adjusted as described in the following.
Patients with Renal lmpairment:
Fluconazole is predominantly excreted in the urine as unchanged drug. No adjustments in single-dose therapy are necessary. In patients with impaired renal function who will receive multiple doses of fluconazole, an initial loading dose of 50 mg to 400 mg should be given. After the loading dose, the daily dose (according to indication) should be based on the following table: (See table.)
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