To Optimize Fluconazole Dosing, Consider Body Weight and Sex

Obese male patients may require higher fluconazole dosing to achieve adequate drug exposure for management of invasive fungal infections.

Since fluconazole's approval in 1993, the prevalence of obesity in the U.S. has risen substantially, raising questions about altered drug bioavailability as a result of augmented gastric emptying and renal clearance among obese patients. Researchers in the Netherlands performed a prospective pharmacokinetic study in 17 obese patients (BMI >35.0 kg/m²) and 8 nonobese controls after receipt of 400 mg oral fluconazole as capsules followed 2 hours later by 400 mg intravenous (IV) fluconazole. Multiple blood samples were collected after both oral and IV fluconazole, and plasma concentrations were used to construct a pharmacokinetic model.

Fluconazole was 87.5% bioavailable in both obese and nonobese subjects. Fluconazole clearance and volumes of …

Reviewing Author

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases