Current Fungal Infection Reports

, Volume 4, Issue 2, pp 120-128

First online:

Antifungal Dose Adjustment in Renal and Hepatic Dysfunction: Pharmacokinetic and Pharmacodynamic Considerations

  • Jason M. CotaAffiliated withDepartment of Pharmacy Practice, University of the Incarnate Word Feik School of Pharmacy
  • , David S. BurgessAffiliated withUniversity of Texas at Austin College of Pharmacy,University of Texas Health Science Center at San Antonio, Pharmacotherapy Education and Research Center Email author 

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Adjusting the dose of antifungal agents for renal and hepatic impairment can be challenging given that clinicians must rely on limited pharmacokinetic data to derive specific regimens. These pharmacokinetic studies are typically performed in a small number of patients without invasive fungal infection, and results are not often reported in concert with accepted pharmacodynamic indices. This article aims to review pertinent pharmacokinetic studies of antifungal drugs in patients with renal or hepatic dysfunction. The impact of novel continuous renal replacement therapy techniques on the pharmacokinetic disposition of antifungal agents will also be described where data are available. Subsequently, this review provides recommendations for antifungal drug dosing in patients with kidney or liver dysfunction after accounting for established or emerging pharmacokinetic-pharmacodynamic relationships as they relate to antifungal drug efficacy in vivo.


Renal replacement therapy Triazoles Echinocandins Antifungal drugs Dosage Kidney dysfunction Liver dysfunction