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Drug Interactions between Diflucan and miconazole

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

fluconazole miconazole

Applies to: Diflucan (fluconazole) and miconazole

MONITOR: Coadministration with fluconazole may increase the plasma concentrations of drugs that are substrates of CYP450 3A4. The mechanism is decreased clearance due to inhibition of CYP450 3A4-mediated metabolism by fluconazole, a moderate inhibitor of the isoenzyme. A 30% increase in serum carbamazepine has been observed during coadministration with fluconazole according to the product labeling. There have also been a few isolated case reports in the medical literature describing an approximate doubling of carbamazepine levels following the addition of fluconazole, resulting in toxicity. Other drugs metabolized by CYP450 3A4 whose plasma levels reportedly are increased by fluconazole include oral contraceptives (ethinyl estradiol and levonorgestrel), cyclosporine, tacrolimus, and cisapride. These interactions have usually been observed with higher dosages of fluconazole (200 mg/day or more).

MANAGEMENT: Caution is advised when fluconazole is used with medications that undergo metabolism by CYP450 3A4, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever fluconazole is added to or withdrawn from therapy.

References

  1. Sugar AM, Saunders C, Idelson BA, Bernard DB "Interaction of fluconazole and cyclosporine." Ann Intern Med 110 (1989): 844
  2. Canafax DM, Graves NM, Hilligoss DM, et al. "Interaction between cyclosporine and fluconazole in renal allograft recipients." Transplantation 51 (1991): 1014-8
  3. Torregrosa V, De la Torre M, Campistol JM, et al. "Interaction of fluconazole with ciclosporin A." Nephron 60 (1992): 125-6
  4. Barbara JA, Clarkson AR, LaBrooy J, et al. "Candida albicans arthritis in a renal allograft recipient with an interaction between cyclosporin and fluconazole." Nephrol Dial Transplant 8 (1993): 263-6
  5. "Product Information. Diflucan (fluconazole)." Roerig Division PROD (2002):
  6. Lopez-Gil JA "Fluconazole-cyclosporin interaction: a dose-dependent effect?" Ann Pharmacother 27 (1993): 427-30
  7. Baciewicz AM, Baciewicz FA, Jr "Ketoconazole and fluconazole drug interactions." Arch Intern Med 153 (1993): 1970-6
  8. Assan R, Fredj G, Larger E, Feutren G, Bismuth H "FK 506/fluconazole interaction enhances FK 506 nephrotoxicity." Diabete Metab 20 (1994): 49-52
  9. Osowski CL, Dix SP, Lin LS, Mullins RE, Geller RB, Wingard JR "Evaluation of the drug interaction between intravenous high-dose fluconazole and cyclosporine or tacrolimus in bone marrow transplant patients." Transplantation 61 (1996): 1268-72
  10. Bedford TA, Rowbotham DJ "Cisapride: drug interactions of clinical significance." Drug Saf 15 (1996): 167-75
  11. Sinofsky FE, Pasquale SA "The effect of fluconazole on circulating ethinyl estradiol levels in women taking oral contraceptives." Am J Obstet Gynecol 178 (1998): 300-4
  12. Nair DR, Morris HH "Potential fluconazole-induced carbamazepine toxicity." Ann Pharmacother 33 (1999): 790-2
  13. Dresser GK, Spence JD, Bailey DG "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet 38 (2000): 41-57
  14. Michalets EL, Williams CR "Drug interactions with cisapride: clinical implications." Clin Pharmacokinet 39 (2000): 49-75
  15. Hilbert J, Messig M, Kuye O, Friedman H "Evaluation of interaction between fluconazole and an oral contraceptive in healthy women." Obstet Gynecol 98 (2001): 218-23
  16. Ulivelli M, Rubegni P, Nuti D, Bartalini S, Giannini F, Rossi S "Clinical evidence of fluconazole-induced carbamazepine toxicity." J Neurol 251 (2004): 622-3
  17. Tsouli S, Maranis S, Kyritsis AP "Fluconazole-carbamazepine interaction in a patient with bipolar disorder." Psychiatry Clin Neurosci 65 (2011): 112
  18. Finch CK, Green CA, Self TH "Fluconazole-carbamazepine interaction." South Med J 95 (2002): 1099-100
View all 18 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Antifungal agents

Therapeutic duplication

The recommended maximum number of medicines in the 'antifungal agents' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antifungal agents' category:

  • Diflucan (fluconazole)
  • miconazole

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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