Monday, January 25, 2016

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%

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