Drug Interactions between fluconazole and nilutamide

Nilutamide can be taken with or without food or milk. Try to take your dose of nilutamide at the same time every day. Alcohol may cause facial flushing, dizziness, and other symptoms in approximately 5% of patients when used during treatment with nilutamide. Do not drink alcohol if you experience any of these symptoms.

The use of nilutamide is contraindicated in patients with severe respiratory impairment. Patients with pulmonary dysfunction may be at increased risk for nilutamide- associated interstitial pneumonitis. Patients should be instructed to immediately report any signs or symptoms of respiratory impairment such as dyspnea, cough, chest pain, or fever. Clinical monitoring of pulmonary function, including pre-treatment chest X-ray, is recommended.

The use of fluconazole has been rarely associated with hepatotoxicity. Reversible idiosyncratic hepatitis, cholestasis and fatal fulminant hepatic failure have been reported, the latter occurring primarily in patients with serious underlying medical conditions and taking multiple concomitant medications. Liver function tests should be performed periodically in patients with preexisting hepatic abnormalities, particularly during prolonged therapy. Treatment should be withdrawn if persistent elevations or worsening of liver enzyme levels occur.

The use of nilutamide is contraindicated in patients with severe hepatic impairment. Patients with hepatic dysfunction may be at increased risk for nilutamide- associated hepatitis and marked increases in liver enzymes. Nilutamide is extensively metabolized by the liver and the metabolic activity and disposition of nilutamide may be altered in patients with severe hepatic impairment. Patients should be instructed to immediately report any sign or symptoms of hepatic dysfunction such as jaundice, dark urine, right upper quadrant pain, or anorexia. Clinical monitoring of hepatic function is recommended and nilutamide should be discontinued if liver transaminase levels increase two to three times the upper limit of normal.

Some azole antifungals have been associated with prolongation of the QT interval on the ECG. Rare cases of QT prolongation and torsade de pointes have been reported during postmarketing experience; such reports usually involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications. These drugs should be administered with caution to patients with potentially proarrhythmic conditions, such as congenital/acquired QT prolongation, cardiomyopathy (especially when heart failure is present), sinus bradycardia, and existing symptomatic arrhythmias. Concomitant use with other medications that have potential to increase the risk of cardiotoxicity should be avoided.

Fluconazole is substantially removed by hemodialysis. Plasma levels of fluconazole has been shown to reduce by 50% following 3 hours of dialysis. Fluconazole should be administered after hemodialysis.

Fluconazole is primarily eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from fluconazole due to decreased drug clearance. Dosage adjustments are recommended for patients with moderate to severe renal impairment (CrCl <= 50 mL/min) receiving multiple doses of the drug.