What is the proper dosage and administration of fluconazole (antifungal medication) for treating vaginal infections?

How to Take Fluconazole for Vaginal Infection

For uncomplicated vaginal yeast infections, take a single 150 mg oral dose of fluconazole—this is the standard treatment with over 90% effectiveness. 1, 2

Standard Dosing for Uncomplicated Vaginal Candidiasis

• Take one 150 mg fluconazole tablet by mouth as a single dose 1, 3
• The medication can be taken with or without food 1
• Clinical cure or improvement occurs in 94-97% of patients within 14 days 4, 5
• No additional doses are needed for straightforward cases 3

When You Need More Than One Dose

For severe vaginal yeast infections, take fluconazole 150 mg every 72 hours (every 3 days) for a total of 2-3 doses. 2, 6

This extended regimen is specifically indicated when you have:

• Severe symptoms (extensive redness, swelling, or multiple vulvar fissures) 6
• Intense itching and discomfort that is debilitating 3

The two-dose regimen achieves significantly higher cure rates in severe cases compared to single-dose therapy (P = 0.015) 6

Recurrent Infections Require Different Management

If you experience 4 or more yeast infections per year, the approach changes substantially 3:

Initial treatment phase:

• Take either 10-14 days of topical antifungal therapy OR oral fluconazole for the same duration 2, 3

Maintenance phase (critical for preventing recurrence):

• Take fluconazole 150 mg once weekly for 6 months 3
• This maintenance regimen significantly reduces recurrence rates 2
• Do not skip this maintenance phase—recurrent infections will likely return without it 3

Special Situations

If you have diabetes or are immunocompromised:

• You fall into the "complicated" category and need longer treatment duration (10-14 days) 3
• A single dose is insufficient for adequate response 3

If the infection is caused by Candida glabrata (fluconazole-resistant):

• Fluconazole will not work effectively 3
• Use boric acid 600 mg vaginal capsules daily for 14 days instead 2, 3
• Alternative: nystatin vaginal suppositories 100,000 units daily for 14 days 2

Important Clinical Considerations

Common pitfalls to avoid:

• Do not use fluconazole if you are pregnant or breastfeeding—it is not recommended in these situations 7
• If symptoms persist after 2-3 days or recur within 2 months, return for medical evaluation 3
• Self-diagnosis of yeast infections is unreliable in 30-50% of cases—confirm the diagnosis with testing before treatment 3
• Drug interactions can occur with fluconazole, particularly with warfarin, oral diabetes medications, phenytoin, and certain heart medications 3

Expected timeline:

• Symptom relief typically begins within 24-48 hours 3
• Complete resolution occurs within 48-72 hours in most cases 3
• Mycological cure (yeast eradication) takes 4-7 days 3

Side effects are generally mild:

• 27% of patients report mild side effects, primarily nausea, abdominal pain, or headache 4, 3
• Serious adverse effects are rare 6
• Abnormal liver enzymes occur rarely and are usually clinically insignificant 5, 3