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Drug Interactions between ashwaganda and voriconazole

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

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Interactions between your drugs

Moderate

voriconazole ashwagandha

Applies to: voriconazole and ashwaganda

MONITOR: Concomitant use of ashwagandha with other agents that are known to induce hepatotoxicity may theoretically increase the risk of hepatotoxicity. There are case reports of adverse effects on liver functions associated with ashwagandha use. In a case report, a 20-year-old man in Japan developed liver dysfunction and hyperbilirubinemia after using ashwagandha in combination with multiple antianxiety drugs. In additional case reports, three men and two women, age range 21 to 62 years who reportedly took supplements containing 450 to 1,350 mg ashwagandha daily over the course of one week to four months when signs of liver injury, such as jaundice, pruritus, nausea, lethargy, abdominal discomfort, and hyperbilirubinemia, appeared.

MANAGEMENT: Liver function tests should be monitored, and patients should be advised to report any symptoms such as abdominal pain, jaundice, dark urine, light stools, fever, or unusual fatigue.

References (6)
  1. (2024) "Product Information. Ashwagandha (ashwagandha)." Now Foods, 1
  2. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health Office of Dietary Supplements Ashwagandha https://www.nccih.nih.gov/health/ashwagandha
  3. inagaki k, mori n, honda y, takaki k, tsuji k (2017) "A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by Ashwagandha" Kanzo, 58, p. 448-454
  4. Bjornsson HK, Bjornsson ES, Avula B, Khan IA, Jonasson JG (2020) "Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network" Liver Int, 40, p. 825-829
  5. Lubarska M, Halasinski P, Hryhorowicz S, et al. (2023) "Liver Dangers of Herbal Products" Int J Environ Res Public Health, 20, p. 3921
  6. Ireland PJ, Hardy T, burt ad, Donnelly MC (2021) "Drug-induced hepatocellular injury due to herbal supplement ashwagandha" J R Coll Surg Edinb, 51, p. 363-365

Drug and food interactions

Moderate

voriconazole food

Applies to: voriconazole

ADJUST DOSING INTERVAL: Food reduces the oral absorption and bioavailability of voriconazole. According to the product labeling, administration of multiple doses of voriconazole with high-fat meals decreased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by 34% and 24%, respectively, when the drug is administered as a tablet, and by 58% and 37%, respectively, when administered as the oral suspension.

MANAGEMENT: To ensure maximal oral absorption, voriconazole tablets and oral suspension should be taken at least one hour before or after a meal.

References (2)
  1. (2002) "Product Information. VFEND (voriconazole)." Pfizer U.S. Pharmaceuticals
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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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

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