What is the dose and frequency of Diflucan (Fluconazole)?

From the Guidelines

Diflucan (Fluconazole) dosing is typically 800 mg (12 mg/kg) as a loading dose, followed by 400 mg (6 mg/kg) daily.

Key Points

• The loading dose of 800 mg (12 mg/kg) is recommended for initial therapy in selected patients, including those who are not critically ill and who are considered unlikely to have a fluconazole-resistant Candida species 1.
• The maintenance dose of 400 mg (6 mg/kg) daily is recommended for patients who are clinically stable, have isolates that are susceptible to fluconazole, and have negative repeat blood cultures following initiation of antifungal therapy 1.
• For patients with C. glabrata infections, a higher dose of 800 mg (12 mg/kg) daily may be considered, but this has not been validated in clinical trials 1.
• Dose reduction is needed in patients with creatinine clearance <50 mL/minute, as fluconazole elimination is almost entirely renal 1.
• The recommended duration of therapy for candidemia without obvious metastatic complications is for 2 weeks after documented clearance of Candida species from the bloodstream and resolution of symptoms attributable to candidemia 1.

Administration

• Fluconazole can be administered orally or intravenously, with oral bioavailability resulting in concentrations equal to approximately 90% of those achieved by intravenous administration 1.
• Absorption is not affected by food consumption, gastric pH, or disease state 1.

From the FDA Drug Label

The recommended dosage of fluconazole tablets for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once daily. For the treatment of Candida urinary tract infections and peritonitis, daily doses of 50 to 200 mg have been used in open, noncomparative studies of small numbers of patients. The recommended dosage for treatment of acute cryptococcal meningitis is 400 mg on the first day, followed by 200 mg once daily The recommended fluconazole tablets daily dosage for the prevention of candidiasis in patients undergoing bone marrow transplantation is 400 mg, once daily The following dose equivalency scheme should generally provide equivalent exposure in pediatric and adult patients:

• 3 mg/kg = 100 mg
• 6 mg/kg = 200 mg
• 12 mg/kg = 400 mg

The dose and frequency of Diflucan (Fluconazole) varies depending on the indication:

• Esophageal candidiasis: 200 mg on the first day, followed by 100 mg once daily
• Urinary tract infections and peritonitis: 50 to 200 mg daily
• Cryptococcal meningitis: 400 mg on the first day, followed by 200 mg once daily
• Prophylaxis in patients undergoing bone marrow transplantation: 400 mg once daily
• Pediatric patients: 3-12 mg/kg daily, depending on the indication and age of the patient 2

From the Research

Dose and Frequency of Diflucan (Fluconazole)

• The dose and frequency of Diflucan (Fluconazole) vary depending on the type of fungal infection being treated 3, 4, 5.
• For patients with oropharyngeal or oesophageal candidiasis, a dose of 200 to 400mg once daily is recommended 3.
• In cases of deep-seated candidiasis, a dose of 200 to 400mg once daily is also recommended 3.
• For the treatment of coccidioidal meningitis, a beneficial clinical effect has been reported with oral fluconazole, but the optimal dose and duration of treatment are not yet established 3.
• In patients with cryptococcal meningitis, fluconazole has been shown to be effective at a dose of 200 to 400mg once daily 3.
• A loading dose of fluconazole, equal to double the maintenance dose, is recommended due to the long elimination half-life of the drug 4.
• The maintenance dose of fluconazole should be adjusted based on renal function, with a dose reduction recommended in patients with renal insufficiency 4, 6.
• The Infectious Diseases Society of America (IDSA) guidelines recommend a fluconazole dose of at least 6 mg/kg/d for the treatment of candidemia, with a dose of at least 12 mg/kg/d recommended after identification of Candida glabrata 6.
• Once-weekly oral doses of fluconazole 150 mg have been shown to be effective in the treatment of tinea corporis/cruris and cutaneous candidiasis 7.