| Antimicrobial |
Dosage Adjustment |
| Amphotericin B |
No change necessary |
| Flucytosine |
No change necessary |
| Anidulafungin |
No change necessary |
| Caspofungin |
Reduce maintenance dose from 50 mg daily to 35 mg daily in patients with moderate (Child Pugh B) hepatic impairment. No information available for patients with severe (Child Pugh C) hepatic impairment. |
| Micafungin |
No change necessary in patients with mild to moderate (Child Pugh A or B) impairment. No information available for patients with severe (Child Pugh C) hepatic impairment. |
| Fluconazole |
No change necessary |
| Isavuconazole |
No change necessary in patients with mild to moderate (Child Pugh A or B) impairment. No information available for patients with severe (Child Pugh C) hepatic impairment. |
| Ketoconazole |
Dosage reduction recommended |
| Itraconazole |
No change necessary |
| Terbinafine |
Reduce dosage by 50% and monitor liver function tests. |
| Voriconazole |
Use standard loading dose followed by half the standard maintenance dose in patients with mild to moderate hepatic impairment (Child Pugh A and B). No data is available for patients with severe hepatic impairment (Child-Pugh C). Additional monitoring of liver function tests is recommended in patients with any degree of abnormal liver function. |
