IV Fluconazole: Renal Adjustment

• Fluconazole is cleared primarily by renal excretion as unchanged drug.
• Renal adjustments vary according to practice, facility and indications.
• In patients with impaired renal function who will receive multiple doses of fluconazole, an initial loading dose of 50 to 400 mg should be given.
• After the loading dose, the daily dose (according to indication) should be based on the following

Creatinine Clearance (mL/min)	Percent of Recommended Dose
>50	100%
<50 (no dialysis)	50%
Regular dialysis	100% after each dialysis Non-dialysis day: receive reduced dose based on their creatinine clearance

Drug Information Leaflet

	30-> 50ml/min	10- <10 / Dialysis	CRRT
Candidiasis	200mg q24h
Fungal Infection	6-12 mg/kg q24h	3-6 mg/kg q24h	6-12 mg/kh q24h

ANTI-INFECTIVE DOSING RECOMMENDATIONS FOR RENAL DYSFUNCTION: ADULT NewYork-Presbyterian Hospital

 

Renal Dosage Adjustment Guidelines for Antimicrobials, www.nebraskamed.com/asp

 UWHC Clinical Directive for Renal Function-Based Dose Adjustments in Adults

Recommendations:

• Based on consistent evidence, it is recommended to give the indicated dose for both loading dose and during dialysis. On non-dialysis days, it is recommended to reduce the dose by 50%