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Dosage adjustment of methadone may be necessary. Olaparib Moderate inhibitors of CYP3A4 such as fluconazole increase olaparib plasma concentrations; concomitant use is not recommended. Oral Contraceptives Two pharmacokinetic studies with a Fluconazole Rx Online oral contraceptive have been performed using multiple doses of fluconazole. Thus, multiple-dose use of fluconazole at these doses is unlikely to have an effect on the efficacy of the combined oral contraceptive.
When Fluconazole Rx Online is used concomitantly with these or other sulfonylurea oral hypoglycemic agents, blood glucose concentrations should be carefully monitored and the dose of the sulfonylurea should be adjusted as necessary. Increased pimozide plasma concentrations can lead to QT prolongation and rare occurrences of torsade de pointes. Prednisone There was a case report that a liver-transplanted patient treated with prednisone developed acute adrenal cortex insufficiency when a 3 month therapy with fluconazole was discontinued. The discontinuation of fluconazole presumably caused an enhanced CYP3A4 activity which led to increased metabolism of prednisone.
Patients on long-term treatment with fluconazole and prednisone should be carefully monitored for adrenal cortex insufficiency when fluconazole is discontinued. Use of quinidine has been associated with QT prolongation and rare occurrences of torsade de pointes. Patients receiving rifabutin and fluconazole concomitantly should be carefully monitored. Dosage adjustment of saquinavir may be necessary. Sirolimus Fluconazole increases plasma concentrations of sirolimus presumably by inhibiting the metabolism of sirolimus via CYP3A4 and P-glycoprotein.
No significant pharmacokinetic changes have been observed when tacrolimus is given intravenously. Increased tacrolimus levels have been associated with nephrotoxicity. Terfenadine Because of the occurrence of serious cardiac dysrhythmias secondary to prolongation of the QTc interval in patients receiving azole antifungals in conjunction with terfenadine, interaction studies have been performed. One study at a 200 mg daily dose of fluconazole failed to demonstrate a prolongation in QTc interval. The combined use of fluconazole at doses of 400 mg or greater with terfenadine is contraindicated.
Reduce the dose of tofacitinib when given concomitantly with fluconazole i. Dosage adjustments of triazolam may be necessary. Vinca Alkaloids Although not studied, fluconazole may increase the plasma levels of the vinca alkaloids e. Vitamin A Based on a case report in one patient receiving combination therapy with all-transretinoid acid an acid form of vitamin A and fluconazole, central nervous system CNS related undesirable effects have developed in the form of pseudotumor cerebri, which disappeared after discontinuation of fluconazole treatment.
This combination may be used but the incidence of CNS related undesirable effects should be borne in mind. Monitoring for adverse events and toxicity related to voriconazole is recommended; especially, if voriconazole is started within 24 h after the last dose of fluconazole. Patients receiving this combination should be monitored for the development of zidovudine-related adverse reactions. Dosage reduction of zidovudine may be considered. DIFLUCAN has been associated with rare cases of serious hepatic toxicity, including fatalities primarily in patients with serious underlying medical conditions. In cases of DIFLUCAN-associated hepatotoxicity, no obvious relationship to total daily dose, duration of therapy, sex, or age of the patient has been observed.
Anaphylaxis In rare cases, anaphylaxis has been reported. Fatal outcomes have been reported in patients with serious underlying diseases. Fluconazole should be discontinued in patients treated for superficial fungal infection who develop a rash that may be attributed to fluconazole. These reported anomalies are similar to those seen in animal studies. Epidemiological studies suggest a potential risk of spontaneous abortion and congenital abnormalities in infants whose mothers were treated with 150 mg of fluconazole as a single or repeated dose in the first trimester, but these epidemiological studies have limitations and these findings have not been confirmed in controlled clinical trials.
The QT prolongation caused by other medicinal products such as amiodarone may be amplified via the inhibition of cytochrome P450 CYP 3A4. During post-marketing surveillance, there have been rare cases of QT prolongation and torsade de pointes in patients taking fluconazole. Patients with hypokalemia and advanced cardiac failure are at an increased risk for the occurrence of life-threatening ventricular arrhythmias and torsade de pointes.
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Fluconazole, with or without metabolic activation, was negative in tests for mutagenicity in four strains of S. The disturbances in parturition were reflected by a slight increase in the number of still born pups and decrease of neonatal survival at these dose levels.
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