Fluconazole
Renal

Renal

In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.

If worsening renal function, actual GFR is likely lower than calculated.

If improving renal function, actual GFR is likely higher than calculated eGFR.

Not On Dialysis (EGFR)

0 - 50 eGFR

100-200mg IV/PO q24h (400 mg q24h for more aggressive therapy)

50+ eGFR

400mg IV/PO q24h

Intermittent Dialysis

Give full dose by indication after each HD session

Continuous Dialysis

400mg IV/PO q24h (800 mg IV q24h for more aggressive therapy)