From the Guidelines
For recurrent vaginal candidiasis, the recommended Diflucan (fluconazole) regimen is 150 mg weekly for 6 months, following an initial 10-14 days of induction therapy with a topical agent or oral fluconazole. This approach is based on the strong recommendation and high-quality evidence from the 2016 update by the Infectious Diseases Society of America 1. The induction phase is crucial in clearing the active infection, while the maintenance phase prevents recurrence through long-term suppressive therapy.
Key points to consider when implementing this regimen include:
- The patient should take the medication with or without food at approximately the same time each week during maintenance.
- Common side effects include headache, nausea, and abdominal discomfort.
- Certain medications like rifampin may decrease fluconazole's effectiveness, while fluconazole may increase levels of drugs like warfarin or oral hypoglycemics.
- Liver function monitoring may be necessary for extended treatment.
The mechanism of action of fluconazole involves inhibiting fungal cytochrome P450 enzymes, disrupting ergosterol synthesis in the fungal cell membrane, which leads to increased cell permeability and ultimately cell death. This regimen is effective because it addresses both the immediate infection and prevents the frequent recurrences that characterize this condition, as supported by the clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America 1.
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 dosing for recurrent vaginal candidiasis is not explicitly stated in the provided drug label. However, for a single episode of vaginal candidiasis, the recommended dosage is 150 mg as a single oral dose.
- It is unclear if this dosage is applicable for recurrent cases. 2
From the Research
Diflucan Dosing for Recurrent Vaginal Candidiasis
- The dosing of Diflucan (fluconazole) for recurrent vaginal candidiasis has been studied in several clinical trials 3, 4, 5, 6.
- One study found that an individualized, degressive, prophylactic regimen of fluconazole was effective in preventing clinical relapses in women with recurrent vulvovaginal candidiasis 3.
- The regimen consisted of an induction dose of 600 mg fluconazole during the first week, followed by 200 mg fluconazole weekly for 2 months, then 200 mg biweekly for 4 months, and finally 200 mg monthly for 6 months.
- Another study found that weekly treatment with fluconazole (150 mg) was effective in preventing symptomatic vulvovaginal candidiasis, with 90.8% of women remaining disease-free at 6 months and 42.9% remaining disease-free at 12 months 4.
- A retrospective analysis of women with Candida albicans RVVC found that approximately 19.2% of women were resolved, 17.5% were sporadic, and 63.3% were ongoing after a course of maintenance fluconazole therapy 5.
- A comparison of vaginal nystatin suppositories and oral fluconazole regimens for the treatment of RVVC found that both therapies were effective, with mycological cure rates of 78.3% and 73.8%, respectively 6.
- A systematic review protocol has been published to assess the efficacy of antifungal agents administered orally or intravaginally for the treatment of RVVC 7.