Interactions between diflucan(fluconazole) and Amiodarone (amiodarone)
amiodarone and fluconazole (Major Drug-Drug)
GENERALLY AVOID: Coadministration with azole antifungal agents may significantly increase the plasma concentrations of amiodarone. The proposed mechanism is azole inhibition of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of amiodarone. The use of amiodarone has been associated with 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. Within the azole class, ketoconazole and itraconazole are considered potent inhibitors, while fluconazole is comparatively weak and generally causes clinically significant interactions with CYP450 3A4 substrates only at dosages of 200 mg/day or more.
MANAGEMENT: Given the potential for serious and life-threatening adverse cardiac events associated with increased plasma levels of amiodarone, concomitant use with azole antifungal agents should generally be avoided if possible. Otherwise, caution and close clinical monitoring are recommended, and patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, or syncope.
