What is the recommended oral fluconazole (fluconazole) dose for vulvovaginal candidiasis?

From the Guidelines

The recommended oral fluconazole dose for vulvovaginal candidiasis is a single 150 mg tablet taken by mouth, as indicated in the most recent and highest quality study 1. This one-time dose is typically sufficient to treat uncomplicated vulvovaginal candidiasis (vaginal yeast infection). The medication works by stopping the growth of yeast that causes the infection. Fluconazole is effective because it inhibits the synthesis of ergosterol, an essential component of fungal cell membranes. Most women experience symptom relief within 1-3 days after taking the medication, though complete resolution may take up to 7 days.

For severe or recurrent infections, additional doses may be prescribed, typically as a second 150 mg dose taken 72 hours after the first dose, or in some cases, a maintenance regimen of 150 mg weekly for 6 months to prevent recurrence, as suggested by 1 and 1. Patients should avoid alcohol while taking fluconazole and inform their healthcare provider about any other medications they are taking, as fluconazole can interact with certain drugs. If symptoms persist after treatment, patients should follow up with their healthcare provider. The Centers for Disease Control and Prevention also recommend this dosage in their guidelines, as seen in 1, but the most recent and highest quality evidence is from 1.

Some key points to consider when treating vulvovaginal candidiasis with fluconazole include:

• The importance of confirming the diagnosis before starting treatment, as symptoms can be non-specific and may be caused by other conditions.
• The potential for interactions with other medications, and the need for patients to inform their healthcare provider about any other medications they are taking.
• The possibility of recurrence, and the need for maintenance therapy in some cases.
• The effectiveness of fluconazole in treating vulvovaginal candidiasis, with most women experiencing symptom relief within a few days of taking the medication.

From the FDA Drug Label

Dosage and Administration in Adults: Single Dose Vaginal candidiasis: The recommended dosage of fluconazole tablets for vaginal candidiasis is 150 mg as a single oral dose. The recommended oral fluconazole dose for vulvovaginal candidiasis is 150 mg as a single oral dose 2.

From the Research

Oral Fluconazole Dose for Vulvovaginal Candidiasis

The recommended oral fluconazole dose for vulvovaginal candidiasis is:

• A single dose of 150 mg, as supported by multiple studies 3, 4, 5, 6, 7

Efficacy of the Recommended Dose

The efficacy of a single 150 mg dose of fluconazole has been demonstrated in various studies, with:

• Clinical response rates of 97% and 88% at short-term and long-term assessments, respectively 3
• Eradication of Candida from the vagina in 93% of patients at short-term assessment and 73% at long-term assessment 3
• A therapeutic efficacy rate of 74.7% on Day 28 in Japanese subjects with vulvovaginal candidiasis 5
• Mycological cure rates of 79.2% and 60.4% approximately 1 week and 4 weeks after treatment, respectively 6

Comparison with Other Treatments

Comparative studies have shown that a single oral dose of 150 mg fluconazole is:

• As effective as 3-day intravaginal clotrimazole treatment, with a significant advantage for fluconazole in long-term assessment 7
• An alternative method of treating vulvovaginal candidiasis, although the cost is higher than for clotrimazole 6

Safety and Tolerability

The safety and tolerability of a single 150 mg dose of fluconazole have been demonstrated, with:

• Low incidence of side-effects, mainly mild gastrointestinal complaints 3
• No clinically significant safety issues reported in Japanese subjects with vulvovaginal candidiasis 5
• Few and minor treatment-related side-effects in comparative studies 6, 7