What is the proper administration of fluconazole (an antifungal medication)?

From the Guidelines

Fluconazole should be taken as an 800-mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) daily, as recommended by the Infectious Diseases Society of America for the treatment of candidiasis 1. This dosing regimen is based on high-quality evidence and is considered an acceptable alternative to an echinocandin as initial therapy in selected patients. When taking fluconazole, it is essential to swallow the capsule whole with a full glass of water and take it at approximately the same time each day to maintain consistent blood levels 1. The medication can be taken with or without food, and it is crucial not to skip doses or stop taking the medication early, even if symptoms improve, as this could allow the infection to return 1. Fluconazole works by preventing fungi from producing ergosterol, an essential component of fungal cell membranes, effectively killing the fungi or stopping their growth 1. Common side effects may include headache, nausea, or stomach pain, and it is essential to inform your doctor about all other medications you're taking, as fluconazole can interact with many drugs 1. If you miss a dose, take it as soon as you remember, but skip it if it's almost time for your next dose 1. Some key points to consider when taking fluconazole include:

• Taking the medication exactly as prescribed by your healthcare provider
• Maintaining consistent blood levels by taking the medication at the same time each day
• Not skipping doses or stopping the medication early
• Informing your doctor about all other medications you're taking
• Being aware of potential side effects, such as headache, nausea, or stomach pain
• Following up with your doctor to monitor the effectiveness of the treatment and potential side effects 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. Multiple Dose SINCE ORAL ABSORPTION IS RAPID AND ALMOST COMPLETE, THE DAILY DOSE OF FLUCONAZOLE IS THE SAME FOR ORAL AND INTRAVENOUS ADMINISTRATION In general, a loading dose of twice the daily dose is recommended on the first day of therapy to result in plasma concentrations close to steady-state by the second day of therapy.

The recommended way to take fluconazole is:

• Orally, as the oral absorption is rapid and almost complete
• The daily dose is the same for oral and intravenous administration
• A loading dose of twice the daily dose is recommended on the first day of therapy
• The dose and duration of treatment vary depending on the type of infection being treated, as outlined in the dosage and administration section 2

From the Research

Administration of Fluconazole

• Fluconazole is well established as a first-line management option for the treatment and prophylaxis of localized and systemic Candida albicans infections 3
• It exhibits predictable pharmacokinetics and is effective, well tolerated, and suitable for use in most patients with C. albicans infections, including children, the elderly, and those with impaired immunity 3
• Prophylactic administration of fluconazole can help to prevent fungal infections in patients receiving cytotoxic cancer therapy 3

Dosage and Efficacy

• The efficacy of fluconazole versus itraconazole in vaginal candidiasis has been compared in several studies, with some showing similar efficacy and safety profiles 4
• A study found that itraconazole was more effective in the treatment of vulvovaginal candidiasis compared to fluconazole with a high cure and low relapse rate 5
• Fluconazole is recommended for prophylaxis of recurrent vulvovaginal candidiasis (RVVC) due to its broad-spectrum susceptibility, convenience, and predictable patient tolerance and safety 6

Resistance and Cross-Resistance

• Recent concerns of fluconazole-resistant Candida albicans strains may impact fluconazole use, particularly concerns of overuse 6
• A study found that almost thirteen percent of yeast strains were resistant to fluconazole and 18.5% were resistant to itraconazole, with cross-resistance analyses revealing associations with decreased susceptibilities to other azole derivatives 7