From the Guidelines
Fluconazole can be used in patients with chronic kidney disease (CKD), but a lower dosage is required in patients with creatinine clearance <50 mL/min. When using fluconazole in patients with CKD, it is essential to consider the dosage adjustments to avoid potential toxicity due to drug accumulation. For patients with invasive candidiasis, fluconazole should be administered with a loading dose of 800 mg (12 mg/kg), followed by a daily dose of 400 mg (6 mg/kg); however, a lower dosage is required in patients with creatinine clearance <50 mL/min 1. The following adjustments can be considered:
- For mild to moderate CKD, the daily dose should be reduced
- For severe CKD, the dose should be reduced by 75%
- Patients on regular hemodialysis should receive the full dose after each dialysis session. Common side effects of fluconazole include nausea, headache, and elevated liver enzymes, which should be monitored during treatment 1. It's crucial to check for drug interactions, particularly with medications that prolong the QT interval, as this risk may be heightened in CKD patients. Always consult with a healthcare provider to determine the appropriate dosing based on the specific level of kidney function, the type of fungal infection being treated, and other patient-specific factors. Key considerations when prescribing fluconazole to CKD patients include:
- Monitoring kidney function and adjusting the dose accordingly
- Regular monitoring of liver enzymes and electrolytes
- Avoiding concomitant use with medications that may interact with fluconazole.
From the FDA Drug Label
The pharmacokinetics of fluconazole are markedly affected by reduction in renal function There is an inverse relationship between the elimination half-life and creatinine clearance. The dose of fluconazole may need to be reduced in patients with impaired renal function. Fluconazole should be administered with caution to patients with renal dysfunction.
Use in Patients with Chronic Kidney Disease (CKD):
- Fluconazole can be used in patients with CKD, but with caution.
- The dose of fluconazole may need to be reduced in patients with impaired renal function due to the inverse relationship between the elimination half-life and creatinine clearance.
- Patients with CKD should be monitored closely for adverse reactions and the dose adjusted as necessary 2 2.