The daily dose of fluconazole should be based on the nature and severity of the fungal infection. Most cases of vaginal candidiasis respond to single-dose therapy. Therapy for those types of infections requiring multiple-dose treatment should be continued until clinical parameters or laboratory tests indicate that active fungal infection has subsided. An inadequate period of treatment may lead to recurrence of active infection. Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually require maintenance therapy to prevent relapse.
Adults: For cryptococca/meningitis and cryptococcal infections at other sites, the usual dose is 400 mg on the first day followed by 200-400 mg once daily. Duration of treatment for cryptococcal meningitis will depend on the clinical and mycological response, but is usually at least 6-8 weeks for cryptococcal meningitis.
For the prevention of relapse of cryptococca/ meningitis in patients with AIDS, after the patient receives a full course of primary therapy fluconazole may be administered indefinitely at a daily dose of 200 mg.
For candidemia, disseminated candidiasis and other invasive candida/ infections, the usual dose is 400 mg on the first day followed by 200 mg daily. Depending on the clinical response, the dose may be increased to 400 mg daily. Duration of treatment is based upon the clinical response.
For oropharyngea/candidiasis, the usual dose is 50 mg once daily for 7-14 days. If necessary, treatment can be continued for longer periods in patients with severely compromised immune function.
For atrophic oral candidiasis associated with dentures, the usual dose is 50-100 mg once daily for 7-14 days administered concurrently with local antiseptic measures to the denture.
For other candida/ infections of mucosa, (except vaginal candidiasis), e.g oesophagitis, non-invasive bronchopulmonary infections, candiduria, mucocutaneous candidiasis, etc, the usual effective dose is 50 mg daily, given for 14-30 days.
In unusually difficult cases of mucosa/candidal infections, the dose may be increased up to 100 mg daily.
For vaginal candidiasis, fluconazole 150 mg should be administered as a single oral dose.
For the prevention of candidiasis, recommended dosage is 50-400 mg once daily, based on the patient's risk for developing fungal infection. For patients at high risk of systemic infection, e.g. patients who are anticipated have profound neutropenia, the recommended daily dose is 400 mg once daily. Fluconazole administration should start several days before the anticipated onset of neutropenia and continuing for 7 days after the neutrophil count rises >1000 cells/mm3
For dermal infections including tinea pedis, corporis, cruris and candida infections the recommended dosage is 150 mg once weekly or 50 mg once daily. Duration of treatment is normally 2-4 weeks but tinea pedis may require treatment for up to 6 weeks. For tinea versicolor, the recommended dose is 50 mg once daily for 2-4 weeks.
As with similar infections in adults, the duration of treatment is based on clinical and mycological response. Fluconazole is administered as a single dose each day.
In children: As with similar infections in adults, the duration of treatment is based on the clinical and mycological response. The maximum adult daily dosage should not be exceeded in children. Fluconazole is administered as a single dose each day.
For oropharyngeal candidiasis:
Recommended dose is 3 mg/kg daily. A loading dose of 6 mg/kg may be used on the first day to achieve steady-state levels more rapidly.
For treatment of cryptococcal meningitis: Recommended dose is 6-12 mg/kg daily, depending on the severity of the disease.
Prevention of fungal infections in immunocompromised patients considered at risk as a consequence of neutropenia following cytotoxic chemotherapy or radio therapy: 3-12 mg/kg daily, depending on the extent and duration of the induced neutropenia (see adult dosing).
Children <4 weeks: Neonates excrete fluconazole slowly. In the first weeks of life, the same mg/kg dosing as in older children should be used but administered every 72 hours. During weeks 2-4 of life, the same dose should be given every 48 hours.
Use in Elderly: When there is no evidence of renal impairment, normal dosage recommendations should be adopted. For patients with renal impairment (creatinine clearance < 50 ml/min) the dosage schedule should be adjusted as described as follows.
In patients with renal impairment:
Fluconazole is predominantly excreted in the urine as unchanged drug. No adjustments in single-dose therapy are necessary. In patients with impaired renal function who will receive multiple doses of fluconazole, an initial loading dose of 50 mg to 400 mg should be given. After the loading dose, the daily dose (according to indication) should be based on the following table. (See table.)
Click on icon to see table/diagram/image
Route of Administration: