Drug interactions between Diflucan and Xanax
| Results for the following 2 drugs: |
|---|
| Diflucan (fluconazole) |
| Xanax (alprazolam) |
Interactions between your selected drugs
fluconazole ↔ alprazolam
Applies to:Diflucan (fluconazole) and Xanax (alprazolam)
GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 3A4 including azole antifungal agents may significantly increase the plasma concentrations of benzodiazepines that are primarily metabolized by the isoenzyme. In pharmacokinetic studies, itraconazole (200 mg/day) and ketoconazole (400 mg/day) individually increased the systemic exposure (AUC) of a single 0.25 mg oral dose of triazolam and a 7.5 mg oral dose of midazolam by more than 22-fold and 10-fold, respectively, compared to placebo. The AUC of a single 2 mg IV dose of midazolam increased 5-fold after pretreatment with ketoconazole. Itraconazole and ketoconazole increased the AUC of alprazolam (0.8 and 1 mg single oral dose) 2.5- and 4-fold, respectively, compared to placebo. Fluconazole, a weaker CYP450 3A4 inhibitor, increased the AUC of a single 0.25 mg oral dose of triazolam by 1.6-, 2.1- and 4.4-fold at dosages of 50 mg, 100 mg and 200 mg once a day, respectively, relative to placebo. A single oral dose of fluconazole 150 mg plus midazolam 10 mg resulted in only modest increases in midazolam plasma concentrations and pharmacologic effects. Overall, pharmacodynamic changes associated with the interaction include increased and prolonged sedation, enhanced benzodiazepine-related EEG effects, and increased impairment of psychomotor performance. The interaction is subject to a high degree of interpatient variability.
MANAGEMENT: Although clotrimazole, fluconazole, miconazole, and voriconazole are weaker inhibitors of CYP450 3A4 than itraconazole and ketoconazole, product labelings for alprazolam and triazolam recommend against use with any azole antifungal agent. The same precaution probably applies also to oral midazolam and high dosages of intravenous midazolam. Terbinafine may be an appropriate alternative, as it is not an inhibitor of CYP450 3A4 and has been shown to have no effect on the pharmacokinetics of midazolam and triazolam. Alternatively, benzodiazepines that are not metabolized by CYP450 3A4 (e.g., lorazepam, oxazepam, temazepam) may be considered in patients requiring treatment with azole antifungal agents. Limited data suggest that fluconazole given intermittently (e.g., 150 mg once or once a week) may be safely administered in combination with midazolam and possibly other benzodiazepines.
See also...
Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
| 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. |
Do not stop taking any medications without consulting your healthcare provider.
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