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Dosing & administration
Dosing varies by indication and patient profile. Always follow your institution's current prescribing guidelines.
Renal impairment
Consult protocols for adjustment.
Liver impairment
Consult protocols for adjustment.
Use during pregnancy
1st trimester
Avoid oral fluconazole. Risk of miscarriage and cardiac defects reported for single-dose exposure. Use topical azoles.
2nd trimester
Use only for serious systemic fungal infections where benefits outweigh risks. Avoid for uncomplicated vaginal candidiasis.
3rd trimester
Same as T2.
Clinical note
Oral fluconazole has a significant gestational-age-dependent risk profile. A single low dose (150 mg) for vaginal candidiasis is commonly used but increasingly scrutinized: a large 2016 Danish cohort (n=3,315) found a doubling of spontaneous abortion risk, and a 2020 NEJM study identified a significant association between single-dose and high-dose fluconazole use in T1 and cardiac septal defects. High-dose prolonged fluconazole (400–800 mg/day) is a known teratogen causing a distinctive skeletal malformation syndrome. Use topical azoles (clotrimazole, miconazole) as first-line for vaginal candidiasis.
Breastfeeding
Caution. Significant breast milk transfer; infant exposure can reach therapeutic concentrations. Avoid prolonged courses during breastfeeding.
