From the Guidelines
Fluconazole should be administered with an average loading dose of 800 mg (12 mg/kg), followed by an average daily dose of 400 mg (6 mg/kg) for patients with invasive candidiasis. This recommendation is based on the clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America 1.
Key Considerations
- The dosage may need to be adjusted for patients with renal impairment, with a dose reduction of 50% for creatinine clearance <50 mL/minute.
- Fluconazole is readily absorbed, with oral bioavailability resulting in concentrations equal to approximately 90% of those achieved by intravenous administration.
- It has the greatest penetration into the cerebrospinal fluid (CSF) and vitreous, achieving concentrations of >70% of those in serum, making it a preferred option for CNS and intraocular Candida infections.
- Fluconazole achieves urine concentrations that are 10–20 times the concentrations in serum, making it the preferred treatment option for symptomatic cystitis.
Important Details
- The higher-dose level (800 mg daily, 12 mg/kg) is often recommended for therapy of susceptible C. glabrata infections, but this has not been validated in clinical trials.
- Fluconazole elimination is almost entirely renal, thus a dose reduction is needed in patients with creatinine clearance <50 mL/minute.
- Common side effects include nausea, headache, skin rash, and elevated liver enzymes, and patients should be monitored for drug interactions as fluconazole can affect the metabolism of many medications.
From the FDA Drug Label
Esophageal candidiasis: The recommended dosage of fluconazole tablets for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Systemic Candida infections: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia, optimal therapeutic dosage and duration of therapy have not been established. 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.
The recommended dosage of Fluconazole for treating Candida infections is as follows:
- Esophageal candidiasis: 200 mg on the first day, followed by 100 mg once daily
- Systemic Candida infections: optimal dosage has not been established, but doses up to 400 mg/day have been used
- Urinary tract infections and peritonitis: 50 to 200 mg daily 2
From the Research
Recommended Dosage of Fluconazole for Treating Candida
- The recommended dosage of Fluconazole for treating Candida varies depending on the severity and type of infection.
- For vaginal candidiasis, a single oral dose of 150 mg Fluconazole is effective, with cure rates of over 80% 3, 4.
- For severe or recurrent Candida vaginitis, a 2-dose regimen of 150 mg Fluconazole given 3 days apart may be more effective, achieving higher clinical cure rates and mycologic eradication 5.
- For systemic fungal infections, Fluconazole can be administered at a dosage of 200-400 mg daily for a mean duration of 15 days, with a clinical and mycological response achieved in 62% and 65% of patients with proven or probable Candida albicans infections, respectively 6.
- For the prevention of mucosal candidiasis in women with HIV infection, weekly Fluconazole (200 mg) has been shown to be safe and effective in preventing oropharyngeal and vaginal candidiasis 7.