Fluconazole
Renal - Adult

Renal - Adult

**High oral bioavailability – consider switching IV to PO when taking PO**
  • CrCl < 50 mL/min: Consider 50% reduction in normal dose
  • Dialysis (HD): Standard load; maintenance doses post-HD on HD days

CVVHD Fluconazole has paradoxically increased clearance in CRRT

  • Normal dose 100 mg Q24h: 200 mg Q24h
  • Normal dose 200 mg Q24h: 400 mg Q24h
  • Normal dose 400 mg Q24h: 800 mg load, then 400 mg Q12h
  • Normal dose 800 mg Q24h: 1.2 g load, then 400 mg Q8h (1.2 g/day)

Notes

  • CRRT recommendations are based on data for ≤ 3L/hr
  • For CRRT > 3L/hr page Infectious Diseases Pharmacy (RRMC p99917; SMH p91059)