Drug Interactions between Clotrimazole Troche and Quin-Release

GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 3A4 including azole antifungal agents may significantly increase the plasma concentrations of quinidine, which is primarily metabolized by the isoenzyme. The use of quinidine has been associated with dose-related prolongation of the QT interval, thus elevated plasma levels of the drug may potentiate the risk of ventricular arrhythmias such as ventricular tachycardia and torsade de pointes as well as cardiac arrest and sudden death. The interaction has not been studied with clotrimazole troches or miconazole buccal tablets. Although systemic absorption following mucous membrane exposure is limited, the potential for interaction with drugs metabolized by CYP450 3A4 such as quinidine cannot be ruled out.

MANAGEMENT: Given the potential for serious and life-threatening adverse cardiac events associated with increased plasma levels of quinidine, the concomitant use with clotrimazole or miconazole mucous membrane preparations should be avoided if possible. Otherwise, patients should be cautioned about the potential for interaction and advised to seek medical attention if they experience signs and symptoms that could indicate quinidine toxicity such as tinnitus, hearing loss, visual disturbances, diarrhea, dizziness, weakness, headache, syncope, and rapid or irregular heartbeats.

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