{"id":626606,"date":"2024-02-06T17:45:14","date_gmt":"2024-02-06T22:45:14","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=626606"},"modified":"2024-10-25T10:10:42","modified_gmt":"2024-10-25T14:10:42","slug":"fluconazole-interactions","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/fluconazole-interactions\/","title":{"rendered":"Fluconazole interactions to avoid"},"content":{"rendered":"<p><span data-sheets-root=\"1\" data-sheets-value='{&quot;1&quot;:2,&quot;2&quot;:&quot;&quot;}' data-sheets-userformat='{\"2\":6849,\"3\":{\"1\":0},\"9\":1,\"10\":2,\"12\":0,\"14\":{\"1\":2,\"2\":0},\"15\":\"Arial\"}' data-sheets-formula=\"=CONCATENATE(R[0]C[-2],R[0]C[-3],R[0]C[-1])\"><\/span><\/p>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/fluconazole\/what-is\"><span style=\"font-weight: 400;\">Fluconazole<\/span><\/a><span style=\"font-weight: 400;\">, also known as the brand name of this medication, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/diflucan\/what-is\"><span style=\"font-weight: 400;\">Diflucan<\/span><\/a><span style=\"font-weight: 400;\">, is a type of <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/antifungals\"><span style=\"font-weight: 400;\">antifungal medication<\/span><\/a><span style=\"font-weight: 400;\"> that treats certain <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/yeast-infection-causes\/\"><span style=\"font-weight: 400;\">yeast infections<\/span><\/a><span style=\"font-weight: 400;\">. These conditions can range from <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/oral-thrush-treatment-and-medications\"><span style=\"font-weight: 400;\">oral thrush<\/span><\/a><span style=\"font-weight: 400;\"> to <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/yeast-infection-treatment-and-medications\"><span style=\"font-weight: 400;\">vaginal candidiasis<\/span><\/a><span style=\"font-weight: 400;\"> to systemic Candida infections to cryptococcal meningitis. Many possible interactions occur because fluconazole is a CYP3A4 inhibitor. Fluconazole can also <\/span><a href=\"https:\/\/academic.oup.com\/cid\/article\/43\/12\/1603\/278706\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">prolong the QTc interval<\/span><\/a><span style=\"font-weight: 400;\">, which may result in heart arrhythmias. Those with a family history of certain heart problems may need to avoid Fluconazole.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Caution or avoidance should take place if taking fluconazole with the following medicines:&nbsp;<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Certain immunosuppressants<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Blood thinning medications&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Corticosteroids&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fluoroquinolone<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Macrolide antibiotics<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Antipsychotic medications<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Narcotic pain relievers&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Statins<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Other azole antifungal medicine<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Heart medications used to manage medical conditions associated with irregular heartbeats&nbsp;<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">It&rsquo;s important to be aware of fluconazole interactions as other drugs and foods can cause serious side effects and serious medical problems requiring immediate medical attention.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Consult a healthcare professional or a pharmacist for medical advice before initiating fluconazole to review potential drug interactions and determine the best treatment if alternatives are necessary.&nbsp;<\/span><\/p>\n<p><b>Related: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/fluconazole-side-effects\/\"><b>Fluconazole side effects and how to avoid them<\/b><\/a><\/p>\n<h2 id=\"fluconazole-drug-interactions\"><span style=\"font-weight: 400;\">Fluconazole drug interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The most serious medications that fluconazole interferes with include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Certain antiarrhythmics&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Antifungal medicines<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fluoroquinolone and&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Macrolide antibiotics<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Anti-rejection medications&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Corticosteroids&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Statins<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Analgesics<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Blood thinning medications.&nbsp;<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Fluconazole can inhibit the metabolism of different medicines from the body by inhibiting the enzyme CYP3A4. CYP3A4 inhibitors are a class of medications that inhibit the activity of a common subtype of an enzyme (cytochrome P450) involved in the metabolism of many medications into inactive forms that the body goes on to eliminate. Inhibition of CYP3A4 can result in increased blood concentrations of other medications that require metabolism through this same route. Serious medical problems may result depending on the concomitant medication whose metabolism is inhibited. Fluconazole can also impact cardiac conduction, resulting in QT prolongation. When taken with other medications with QTc-prolonging potential, the additive effects can be deadly.&nbsp;<\/span><\/p>\n<h3 id=\"qtc-prolonging-agents\"><span style=\"font-weight: 400;\">QTc prolonging agents<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Fluconazole may enhance the QTc-prolonging effect of other QTc-prolonging medications with a single dose, which can result in life-threatening heart rhythm patterns like <\/span><a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/21915-torsades-de-pointes\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">torsades de pointes<\/span><\/a><span style=\"font-weight: 400;\">. The QT interval is the part of an electrocardiogram (EKG) report that represents the time it takes the heart to contract and recover. <\/span><a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/17183-long-q-t-syndrome-lqts\"><span style=\"font-weight: 400;\">Long QT syndromes <\/span><\/a><span style=\"font-weight: 400;\">can be inherited and are the result of an issue with the heart&rsquo;s electrical conduction such that it takes longer than normal to recharge between heartbeats, which is due to an issue with ion channels or the flow of ions (sodium, calcium, potassium, and chloride) in and out of heart muscle cells to produce electrical activity, resulting in an irregular heartbeat. Medications can cause acquired long QT syndrome.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Prolonging the QT interval increases the risk of irregular heartbeats, such as ventricular tachycardias, which can result in cardiac arrest and sudden death due to the heart&rsquo;s inability to pump blood throughout the body effectively.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The class of drugs that can independently prolong the QTc interval are listed below.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Antiarrhythmic medications, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Class IA antiarrhythmics, including:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Disopyramide<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Procainamide<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Quinidine<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Class III antiarrhythmics, including:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Amiodarone<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Dofetilide<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Dronaderone<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Ibutilide<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Sotalol<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Miscellaneous antiarrhythmics, including:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Digoxin<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Fluoroquinolone antibiotics, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ciprofloxacin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Delafloxacin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Levofloxacin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Moxifloxacin<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Macrolide antibiotics, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Azithromycin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clarithromycin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Erythromycin<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Azole antifungals, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ketoconazole<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Isavuconazole<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Posaconazole<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Itraconazole<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Voriconazole<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Antipsychotics, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pimozide<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ziprasidone<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In addition to possible additive QTc prolongation, the CYP3A4 inhibition of fluconazole may also increase the serum concentration of these medications that are dependent on metabolism by this route. This further exacerbates the risk of arrhythmias. Alternatives to these combinations should be considered whenever possible. Additional risk factors, including older adults, female gender, low levels of potassium or magnesium, and a medical history of heart problems, increase the risk of QTc prolongation.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Clinical trials characterizing risks of the combination are limited, but there is substantial evidence regarding the individual drugs causing QTc prolongation or torsades de pointes (TdP). Combined use of drugs that prolong QTc interval raises the concern for further increased risk of serious toxicities, with at least one study demonstrating that the use of <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20394022\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">an additional QT-prolonging drug<\/span><\/a><span style=\"font-weight: 400;\"> is the most common risk factor among patients with QTc prolongation. The <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27896662\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">magnitude of the risk<\/span><\/a><span style=\"font-weight: 400;\"> is also dependent upon the specific drugs and doses used.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Doctors should closely monitor the QTc interval prolongation if concomitant use is necessary. Symptoms of QTc interval prolongation could include the sensation of heart palpitations and a sensation of severe dizziness and fainting. Unfortunately, more serious effects could occur from QTc interval prolongation, including seizure-like activity or sudden cardiac arrest.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">To prevent this, consider alternatives to fluconazole. The selection of alternatives to fluconazole is heavily dependent upon the infection being managed. <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/topical-antifungals\"><span style=\"font-weight: 400;\">Topical antifungals<\/span><\/a><span style=\"font-weight: 400;\"> with minimal systemic absorption may be considered for vulvovaginal candidiasis, whereas echinocandins (only available intravenously) could be considered for more serious infections like systemic candidiasis.&nbsp;<\/span><\/p>\n<h3 id=\"immunosuppressants\"><span style=\"font-weight: 400;\">Immunosuppressants<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Immunosuppressants like cyclosporine, tacrolimus, and sirolimus are medications used in multiple conditions, such as aplastic anemia, bone marrow transplant recipients, graft-versus-host disease, psoriasis, and others. Fluconazole inhibits the metabolism of these agents, increasing their serum concentrations, which can have serious side effects. <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/8477116\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Increased cyclosporine exposure<\/span><\/a><span style=\"font-weight: 400;\"> can result in side effects like kidney failure and liver damage. Due to the interaction with cyclosporine, the general recommendation is to conduct blood tests to monitor for increased cyclosporine concentrations when combined with fluconazole. The dose of cyclosporine could then be modified, likely decreased, to maintain goal levels. Similarly, when a patient is on the combination and fluconazole is discontinued, cyclosporine levels should be monitored closely for the need to increase the dose without this ongoing interaction.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Fluconazole can also increase the blood levels of tacrolimus and sirolimus by inhibiting CYP3A4. Coadministration with tacrolimus and fluconazole doses of more than 100 mg per day will require a <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24938293\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">dose reduction of tacrolimus and sirolimus<\/span><\/a><span style=\"font-weight: 400;\"> by up to 75% to maintain safe blood levels of these immunosuppressants. Supratherapeutic serum concentrations of tacrolimus and sirolimus can also result in serious side effects like renal injury, infections, and secondary malignancies like skin cancer.<\/span><\/p>\n<h3 id=\"corticosteroids\"><span style=\"font-weight: 400;\">Corticosteroids<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Fluconazole, as a moderate CYP3A4 inhibitor, can decrease the metabolism of corticosteroids and, therefore, increase their blood levels and an individual&rsquo;s overall exposure if taken concomitantly. This interaction can increase the risk of adverse corticosteroid effects, and a healthcare provider should employ increased monitoring of such side effects in any person receiving this combination. <\/span><a href=\"https:\/\/www.mayoclinic.org\/steroids\/art-20045692\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Side effects <\/span><\/a><span style=\"font-weight: 400;\">to monitor increased mood changes, insomnia, high blood sugars, and increased blood pressure.&nbsp;<\/span><\/p>\n<p><a href=\"https:\/\/www.singlecare.com\/drug-classes\/corticosteroids\"><span style=\"font-weight: 400;\">Corticosteroids<\/span><\/a><span style=\"font-weight: 400;\"> dependent on CYP3A4 metabolism include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dexamethasone<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Methylprednisolone&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prednisolone&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prednisone<\/span><\/li>\n<\/ul>\n<h3 id=\"analgesics\"><span style=\"font-weight: 400;\">Analgesics<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Certain pain medications can interact with fluconazole through the same mechanisms already discussed&mdash;CYPA3A4 inhibition or additive QTc-prolonging potential. Fentanyl is one such pain medication that interacts with fluconazole via inhibition of CYP3A4-mediated fentanyl metabolism. <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17987285\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Fentanyl doses should be reduced<\/span><\/a><span style=\"font-weight: 400;\"> in the setting of a concomitant CYP3A4 inhibitor until the effects of the combination are known to maintain constant levels of fentanyl in the body. Symptoms of excess fentanyl levels include respiratory depression and excess sedation. Likewise, suppose someone is using both fentanyl and fluconazole. In that case, close observation is necessary for signs of withdrawal upon discontinuing fluconazole, and there might be a need to adjust the fentanyl dosage.&nbsp;<\/span><\/p>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/methadone-hcl\"><span style=\"font-weight: 400;\">Methadone<\/span><\/a><span style=\"font-weight: 400;\"> is another pain medication that may increase the risk of QT prolongation with QT-prolonging CYP3A4 inhibitors like fluconazole. The product labeling for methadone strongly advises exploring alternative options instead of using a combination of these two medications. If no alternatives exist, a doctor should educate the individual to monitor for symptoms of increased methadone toxicities, including respiratory depression.&nbsp;<\/span><\/p>\n<h3 id=\"anticoagulants\"><span style=\"font-weight: 400;\">Anticoagulants<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Warfarin, a Vitamin K Antagonist, is a blood thinning medication used in cardiac conditions like <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/living-with-afib\/\"><span style=\"font-weight: 400;\">atrial fibrillation (afib)<\/span><\/a><span style=\"font-weight: 400;\"> and in managing acute <\/span><a href=\"https:\/\/www.heart.org\/en\/health-topics\/venous-thromboembolism\/what-is-venous-thromboembolism-vte\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">venous thromboembolism (VTE)<\/span><\/a><span style=\"font-weight: 400;\">, otherwise known as <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/tag\/blood-clots\/\"><span style=\"font-weight: 400;\">blood clots<\/span><\/a><span style=\"font-weight: 400;\">. The use of warfarin comes with a risk of bleeding, which is why regularly performed monitoring of the <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507707\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">international normalized ratio (INR)<\/span><\/a><span style=\"font-weight: 400;\"> with goal ranges established based on indication should be performed. Many medications and changes in diet can interact with warfarin, causing changes to a person&rsquo;s INR, which is a measure of how long it takes blood to clot (e.g., the higher the INR, the longer it will take for clotting to occur, meaning the more at risk of a significant bleed).&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When a person is on a combination of warfarin and fluconazole, close monitoring of the effect on the INR is recommended, with a <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/8801058\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">gradual reduction in the warfarin dose <\/span><\/a><span style=\"font-weight: 400;\">when fluconazole is initiated. The mechanism of this interaction is due to fluconazole inhibition of CYP3A4 and another isoenzyme known as CYP2C9, which are primarily responsible for warfarin metabolism.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Other <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/anticoagulants\"><span style=\"font-weight: 400;\">anticoagulants<\/span><\/a><span style=\"font-weight: 400;\"> that depend on CYP3A4 for their metabolism and thus interact with fluconazole, resulting in increased levels of these blood thinners, include apixaban (Eliquis) and rivaroxaban (Xarelto). A doctor should monitor patients on one of these agents with fluconazole for increased bleeding. If patients have decreased kidney function, it is best to avoid the combination entirely. Doctors or other health care providers should provide education about the need to immediately report any signs or symptoms of possible bleeding and seek medical help.&nbsp;<\/span><\/p>\n<h3 id=\"statins\"><span style=\"font-weight: 400;\">Statins<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Azole antifungals can increase the plasma concentrations of <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/statins\"><span style=\"font-weight: 400;\">statins<\/span><\/a><span style=\"font-weight: 400;\"> that metabolize CYP3A4, including atorvastatin, lovastatin, and simvastatin. Concomitant administration with an azole such as fluconazole can result in myopathy or <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/rhabdomyolysis\/\"><span style=\"font-weight: 400;\">rhabdomyolysis<\/span><\/a><span style=\"font-weight: 400;\">. Management of fluconazole interactions with this group of medications includes reducing the statin dose while receiving the azole antifungal or switching the statin to one not as associated with CYP interactions, such as pravastatin.&nbsp;<\/span><\/p>\n<h2 id=\"fluconazole-food-interactions\"><span style=\"font-weight: 400;\">Fluconazole food interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The presence or absence of food in the gastrointestinal tract can impact exposure to azole antifungals when dosing. Voriconazole is best absorbed on an empty stomach, while posaconazole exposure is optimized with a fatty meal or nutritional supplement. Fluconazole absorption is fortunately not affected by food.<\/span><\/p>\n<h3 id=\"fluconazole-and-grapefruit\"><span style=\"font-weight: 400;\">Fluconazole and grapefruit&nbsp;<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Grapefruit juice may increase the amount of a drug available in the body by decreasing the way the body breaks down or metabolizes the medication. Grapefruit interacts with many prescription drugs, and when consumed with fluconazole, it can further increase the risk of drug interactions. Grapefruit juice inhibits CYP3A4, so the inhibition may be additive when taken concomitantly with fluconazole. If fluconazole and grapefruit juice are consumed with another medication that requires metabolism to an inactive form via CYP3A4, its blood levels and potential side effects could increase. Without definitive research to show that grapefruit juice is safe, limiting or avoiding grapefruit juice when taking fluconazole minimally to ensure a consistent intake is important, especially if receiving other medications metabolized by CYP3A4.&nbsp;<\/span><\/p>\n<h2 id=\"other-fluconazole-interactions\"><span style=\"font-weight: 400;\">Other fluconazole interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Fluconazole is metabolized almost exclusively by the liver, so consumption of other medications or substances requiring hepatic metabolism can be problematic, and individuals should be monitored closely for the development of liver injury. Fluconazole should also be used cautiously in certain patient populations, as outlined below.&nbsp;<\/span><\/p>\n<h3 id=\"fluconazole-and-alcohol\"><span style=\"font-weight: 400;\">Fluconazole and alcohol&nbsp;<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">There is no contraindication to consuming alcoholic drinks while taking fluconazole. However, the combination may strain the liver as both fluconazole and alcohol are hepatically metabolized and can, therefore, strain the liver. Alcohol consumption while receiving fluconazole should be in moderation.&nbsp;<\/span><\/p>\n<h3 id=\"fluconazole-and-pregnancy-or-breastfeeding\"><span style=\"font-weight: 400;\">Fluconazole and pregnancy or breastfeeding<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Fluconazole should be avoided in women at a minimum during the first trimester of pregnancy because of the risk of side effects to the unborn baby. There remains some concern about spontaneous abortion when pregnant women consume fluconazole up to week 22 of gestation. Women and their healthcare providers should carefully weigh the risks and benefits of fluconazole during pregnancy. Similarly, healthcare providers should exercise caution when administering fluconazole to breastfeeding mothers, as the drug is present in breast milk. Breastfeeding women prescribed fluconazole should openly communicate the risks and benefits, or possible alternatives, with their medical provider.&nbsp;<\/span><\/p>\n<h3 id=\"fluconazole-and-special-patient-populations\"><span style=\"font-weight: 400;\">Fluconazole and special patient populations<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Older adult patients should use azole antifungals like fluconazole cautiously, ensuring they employ the appropriate dose based on their kidney function, which often diminishes in older age. Similarly, fluconazole should be dose-adjusted and monitored in individuals with kidney or serious liver disease. Apart from the heightened risk of drug accumulation caused by organ function changes, the situation can be worsened by interactions between drugs, leading to severe side effects. There is no restriction on fluconazole use in children.&nbsp;<\/span><\/p>\n<h2 id=\"how-to-minimize-fluconazole-interactions\"><span style=\"font-weight: 400;\">How to minimize fluconazole interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Always carry a complete list of medications, including those that are non-prescription, on your person. Any time you&rsquo;re receiving medical advice with new therapy recommendations, provide this list so that your doctor can perform a thorough review and drug information assessment to minimize the risk of drug interactions. Whenever initiating a new medication and new signs or symptoms arise, it&#8217;s best to review them with your healthcare professional for any potential risks with this medicine.&nbsp;<\/span><\/p>\n<h2 id=\"when-to-talk-to-a-healthcare-provider-about-fluconazole-interactions\"><span style=\"font-weight: 400;\">When to talk to a healthcare provider about fluconazole interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">This article is not a complete list of fluconazole interactions or possible side effects. Be mindful of the risk of side effects and direct drug interactions, which may occur when taking fluconazole in combination with other prescription and over-the-counter medications or supplements.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Directly communicate with a healthcare professional when needing fluconazole, including a single dose for vaginal yeast infections. Communication ensures a thorough review of interactions, including medications, diet, and conditions, for an effective monitoring plan.&nbsp;<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Fluconazole, also known as the brand name of this medication, Diflucan, is a type of antifungal medication that treats certain yeast infections. These conditions can range from oral thrush to vaginal candidiasis to systemic Candida infections to cryptococcal meningitis. Many possible interactions occur because fluconazole is a CYP3A4 inhibitor. Fluconazole can also prolong the QTc [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":626607,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[814,8670],"coauthors":[10869],"class_list":["post-626606","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-drug-interactions","tag-womens-health","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Fluconazole interactions to avoid | SingleCare<\/title>\n<meta name=\"description\" content=\"Fluconazole interacts with antiarrhythmics, antifungal medicines, fluoroquinolone, macrolide antibiotics, and grapefruit juice. 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