Adjustment of Dose & Administration
Indication-Specific Adjustment
Single dose indications:
- Mild intertrigo: 200 mg once
- Candida vaginitis: 150 mg once
Prophylaxis:
- 9100 Hematology Oncology (HOA) Anti-infective Prophylaxis Protocol
- Adult Stem Cell Transplantation Infection Prophylaxis Guidelines
- DUH-Durham Campus Only: Liver Post-Transplant Antimicrobial Prophylaxis (Policy Tech #5719)
Adult Mild to Moderate Infections
Adult Invasive/Serious Infections (ID Consult Required for Candidemia)
Renal Adjustment
See above dosing table.
Drug-Specific Information
Oral bioavailability approximately 100%. Therefore, consider oral formulation unless patient unable to take oral medication, severe infections, or when concerns exist regarding absorption.
Dose conversion: 1:1 IV to PO
Fluconazole use is associated with mild-to-moderate elevations in serum transaminase levels, which are usually asymptomatic and can resolve while continuing therapy. A Meta-Analysis evaluating the tolerability and hepatotoxicity of antifungal therapy found that 9.3% of patients on fluconazole therapy experienced elevated liver enzymes, but only 0.7% of patients had changes in antifungal therapy due to these elevations.
Drug-induced liver injury (DILI) secondary to fluconazole use is rare. True DILI associated with fluconazole typically occurs within the first weeks of starting therapy, is hepatocellular in nature, and is associated with vomiting, nausea, fatigue, upper quadrant tenderness/pain, rash, fever, and/or eosinophilia
General Notes
- Up-to-date cost information, click here
- IV antimicrobials outpatient (OPAT) dosing, click here
- Obesity dosing weight recommendations here
- Helpful drug-drug interaction check website here
- When dosing guidance is provided it is important to note the following:
Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.