What is the recommended dose of Diflucan (fluconazole) for a yeast infection?

Diflucan Dose for Yeast Infection

For uncomplicated vaginal yeast infections, take a single 150 mg oral dose of fluconazole (Diflucan). 1, 2

Uncomplicated Vaginal Candidiasis

• A single 150 mg oral dose is the standard treatment, achieving clinical cure rates exceeding 90% in most patients 1
• This single-dose regimen is as effective as multi-day topical antifungal therapies 1
• The FDA-approved dosing confirms 150 mg as a single oral dose for vaginal candidiasis 2
• Clinical response is typically evident within 5-16 days, with 97% of patients cured or markedly improved 3

Complicated Vaginal Candidiasis

For severe acute vaginal yeast infections, use fluconazole 150 mg every 72 hours for a total of 2-3 doses (i.e., on days 1,4, and optionally day 7). 1, 4, 5

Complicated infections are defined as: 1

• Severe symptoms (extensive vulvar erythema, edema, excoriation, or fissures)
• Recurrent infections (≥4 episodes per year)
• Non-albicans Candida species (particularly C. glabrata)
• Immunocompromised hosts (diabetes, HIV, corticosteroid use)

The multi-dose regimen achieves significantly higher cure rates in severe vaginitis compared to single-dose therapy, particularly at day 14 and day 35 follow-up 5

Recurrent Vaginal Candidiasis

For recurrent infections (≥4 episodes yearly), use a two-phase approach: 1, 4

1. Induction phase: 10-14 days of topical azole therapy OR oral fluconazole (150 mg every 72 hours for 2-3 doses)
2. Maintenance phase: Fluconazole 150 mg once weekly for 6 months

This suppressive regimen prevents relapse in the majority of patients with recurrent disease 1

Important Clinical Considerations

• Confirm the diagnosis with wet mount preparation using 10% potassium hydroxide to visualize yeast or hyphae before treating 1
• Vaginal pH should be <4.5 in candidiasis; higher pH suggests bacterial vaginosis or trichomoniasis 1
• Non-albicans species (especially C. glabrata) may be azole-resistant and require alternative therapy such as topical boric acid 600 mg daily for 14 days 1
• Fluconazole is well-tolerated with minimal side effects, primarily mild gastrointestinal complaints 3
• Avoid during pregnancy and lactation as fluconazole is not recommended in these populations 6

Common Pitfalls

• Do not use single-dose therapy for severe or recurrent infections—these require extended treatment 1, 5
• Do not assume treatment failure is due to fluconazole resistance without confirming the Candida species; C. glabrata requires different management 1
• Relapse rates can reach 23% even after successful initial treatment, so counsel patients about recurrence 3