Fluconazole interactions

Conditions

Conditions in which Fluconazole needs care, as documented in this source.

• Liver Diseases

  Major

  The use of fluconazole has been rarely associated with hepatotoxicity. Reversible idiosyncratic hepatitis, cholestasis and fatal fulminant hepatic failure have been reported, the latter occurring primarily in patients with serious underlying medical conditions and taking multiple concomitant medications. Liver function tests should be performed periodically in patients with preexisting hepatic abnormalities, particularly during prolonged therapy. Treatment should be withdrawn if persistent elevations or worsening of liver enzyme levels occur.

  10 sources

  1. Franklin IM, Elias E, Hirsch C "Fluconazole-induced jaundice." Lancet 336 (1990): 565
  2. Grant SM, Clissold SP "Fluconazole: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial and systemic mycoses." Drugs 39 (1990): 877-916
  3. Holechek MJ "Medication review: fluconazole." ANNA J 18 (1991): 585-6
  4. Munoz P, Moreno S, Berenguer J, et al. "Fluconazole-related hepatotoxicity in patients with acquired immunodeficiency syndrome." Arch Intern Med 151 (1991): 1020-1
  5. Wells C, Lever AM "Dose-dependent fluconazole hepatotoxicity proven on biopsy and rechallenge ." J Infect 24 (1992): 111-2
  6. Jacobson MA, Hanks DK, Ferrell LD "Fatal acute hepatic necrosis due to fluconazole." Am J Med 96 (1994): 188-90
  7. Gearhart MO "Worsening of liver function with fluconazole and review of azole antifungal hepatotoxicity." Ann Pharmacother 28 (1994): 1177-81
  8. "Product Information. Diflucan (fluconazole)." Roerig Division (2001):

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  9. Ruhnke M, Yeates RA, Pfaff G, Sarnow E, Hartmann A, Trautmann M "Single-dose pharmacokinetics of fluconazole in patients with liver cirrhosis." J Antimicrob Chemother 35 (1995): 641-7
  10. Guillaume MP, Deprez C, Cogan E "Subacute mitochondrial liver disease in a patient with AIDS: possible relationship to prolonged fluconazole administration." Am J Gastroenterol 91 (1996): 165-8

• Diseases requiring hemodialysis

  Moderate

  Fluconazole is substantially removed by hemodialysis. Plasma levels of fluconazole has been shown to reduce by 50% following 3 hours of dialysis. Fluconazole should be administered after hemodialysis.

  3 sources

  1. Oono S, Tabei K, Tetsuka T, Asano Y "The pharmacokinetics of fluconazole during haemodialysis in uraemic patients." Eur J Clin Pharmacol 42 (1992): 667-70
  2. Toon S, Ross CE, Gokal R, Rowland M "An assessment of the effects of impaired renal function and haemodialysis on the pharmacokinetics of fluconazole." Br J Clin Pharmacol 29 (1990): 221-6
  3. "Product Information. Diflucan (fluconazole)." Roerig Division (2001):

• Kidney Diseases

  Moderate

  Fluconazole is primarily eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from fluconazole due to decreased drug clearance. Dosage adjustments are recommended for patients with moderate to severe renal impairment (CrCl <= 50 mL/min) receiving multiple doses of the drug.

  3 sources

  1. Toon S, Ross CE, Gokal R, Rowland M "An assessment of the effects of impaired renal function and haemodialysis on the pharmacokinetics of fluconazole." Br J Clin Pharmacol 29 (1990): 221-6
  2. Debruyne D, Ryckelynck JP "Clinical pharmacokinetics of fluconazole." Clin Pharmacokinet 24 (1993): 10-27
  3. "Product Information. Diflucan (fluconazole)." Roerig Division (2001):

• Long QT Syndrome

  Moderate

  Some azole antifungals have been associated with prolongation of the QT interval on the ECG. Rare cases of QT prolongation and torsade de pointes have been reported during postmarketing experience; such reports usually involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications. These drugs should be administered with caution to patients with potentially proarrhythmic conditions. Concomitant use with other medications that have potential to increase the risk of cardiotoxicity should be avoided.

  7 sources

  1. "Product Information. Nizoral (ketoconazole)." Janssen Pharmaceuticals (2001):
  2. "Product Information. Diflucan (fluconazole)." Roerig Division (2002):
  3. "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals (2002):
  4. "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals (2022):
  5. "Product Information. VFEND (voriconazole)." Pfizer U.S. Pharmaceuticals (2002):
  6. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):
  7. "Product Information. Tolsura (itraconazole)." Mayne Pharma Inc (2021):