Table 8 Dose adjustment required in case of renal and hepatic impairment
From: Bench-to-bedside review: Therapeutic management of invasive candidiasis in the intensive care unit
Drug | Dose adjustment | Comments |
|---|---|---|
Renal impairment | Â | Â |
   All echinocandins | None | - |
   Fluconazole | Yes | 50% of the dose if CrCl <50 |
   Itraconazole oral solution | None | Do not use intravenous formulation due to carrier accumulation (cyclodextrin) if CrCl <30 |
   Posaconazole | None | If CrCl <20, monitor closely for breakthrough infections due to the variability in exposure |
   Voriconazole, oral formulation only | None | Do not use intravenous formulation due to carrier accumulation (cyclodextrin) if CrCl <50 |
   Amphotericin B deoxycholate | Do not use | Switch to less nephrotoxic formulation |
   Amphotericin B lipid formulations | Unknown | - |
Hepatic impairment | Â | Â |
   Anidulafungin | None |  |
   Caspofungin | Yes | Moderate hepatic impairment (Child-Pugh score 7 to 9) 35 mg daily, with 70 mg loading dose |
   Micafungin | None | No data in severe hepatic impairment |
   Fluconazole | None |  |
   Itraconazole oral solution | Unknown | Patients with impaired hepatic function should be carefully monitored when taking itraconazole |
   Posaconazole | None |  |
   Voriconazole | Yes | 50% of maintenance dose in mild to moderate hepatic impairment (Child-Pugh class A and B); no data in Child-Pugh class C; patients with hepatic insufficiency must be carefully monitored for drug toxicity |
   Amphotericin B | Unknown |  |