Therapeutic Classification: antifungals (systemic)
Pharmacologic Classification: azoles
Absorption: Well absorbed after oral administration.
Distribution: Widely distributed; good penetration into CSF, saliva, sputum, vaginal fluid, skin, eye, and peritoneum.
Metabolism/Excretion: >80% excreted unchanged by the kidneys; <10% metabolized by the liver.
Half-Life: Premature neonates: 46–74 hr; Children: 19–25 hr (PO) and 15–17 hr (IV); Adults: 30 hr (↑ in renal impairment).
Oropharyngeal Candidiasis
- PO IV (Adults ): 200 mg initially, then 100 mg daily for at least 2 wk.
- PO IV (Children ≥6 mo): 6 mg/kg initially, then 3 mg/kg once daily for ≥2 wk.
Renal Impairment
- PO IV (Adults and Children ≥6 mo): CCr ≤50 mL/min (no hemodialysis): Give 50% of the usual dose; Hemodialysis: Give 100% of the usual dose after each dialysis session; give reduced dose based on CCr on nondialysis days.
Esophageal Candidiasis
- PO IV (Adults ): 200 mg initially, then 100 mg once daily for at least 3 wk (up to 400 mg/day).
- PO IV (Children ≥6 mo): 6 mg/kg initially, then 3 mg/kg once daily/day for ≥3 wk.
Renal Impairment
- PO IV (Adults and Children ≥6 mo): CCr ≤50 mL/min (no hemodialysis): Give 50% of the usual dose; Hemodialysis: Give 100% of the usual dose after each dialysis session; give reduced dose based on CCr on nondialysis days.
Vaginal Candidiasis
- PO (Adults ): 150-mg single dose; prevention of recurrence (unlabeled)—150 mg daily for 3 days then weekly for 6 mo.
Systemic Candidiasis
- PO IV (Adults ): 400 mg/day initially, then 200–800 mg/day for 28 days.
- PO IV (Children ≥3 mo): 25 mg/kg initially (max = 800 mg), then 12 mg/kg once daily (max = 400 mg/day) for ≥3 wk.
- PO IV (Neonates and Children Birth to 3 mo postnatal age and ≥30 wk gestational age): 25 mg/kg initially, then 12 mg/kg once daily for ≥3 wk.
- PO IV (Neonates and Children Birth to 3 mo postnatal age and <30 wk gestational age): 25 mg/kg initially, then 9 mg/kg once daily for ≥3 wk.
Renal Impairment
- PO IV (Adults and Children ): CCr ≤50 mL/min (no hemodialysis): Give 50% of the usual dose; Hemodialysis: Give 100% of the usual dose after each dialysis session; give reduced dose based on CCr on nondialysis days.
Cryptococcal Meningitis
- PO IV (Adults ): Treatment: 400 mg once daily until favorable clinical response, then 200–800 mg once daily for at least 10–12 wk after clearing of CSF; change to oral therapy as soon as possible. Suppressive therapy: 200 mg once daily.
- PO IV (Children ): 12 mg/kg initially, then 6–12 mg/kg once daily for ≥10–12 wk after clearing of CSF; change to oral therapy as soon as possible. Suppressive therapy: 6 mg/kg/day.
Renal Impairment
- PO IV (Adults and Children ): CCr ≤50 mL/min (no hemodialysis): Give 50% of the usual dose; Hemodialysis: Give 100% of the usual dose after each dialysis session; give reduced dose based on CCr on nondialysis days.
Prevention of Candidiasis after Bone Marrow Transplant
- PO IV (Adults ): 400 mg once daily; begin several days before procedure if severe neutropenia is expected, and continue for 7 days after ANC >1000 /mm3.
- PO IV (Children >14 days): 10–12 mg/kg/day, not to exceed 600 mg/day.
Renal Impairment
- PO IV (Adults ): CCr ≤50 mL/min (no hemodialysis): Give 50% of the usual dose; Hemodialysis: Give 100% of the usual dose after each dialysis session; give reduced dose based on CCr on nondialysis days.
