Drug Interactions between fluconazole and perflutren

Serious cardiopulmonary reactions including fatalities have uncommonly occurred during or shortly following perflutren- containing microsphere administration, typically within 30 minutes of administration. The risk may be increased among patients with unstable cardiopulmonary conditions such as acute myocardial infarction, acute coronary artery syndromes, worsening or unstable congestive heart failure, or serious ventricular arrhythmias. Always have cardiopulmonary resuscitation personnel and equipment readily available prior to perflutren administration and monitor all patients for acute reactions.

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 Treatment should be withdrawn if persistent elevations or worsening of liver enzyme levels occur.

Serious cardiopulmonary reactions including fatalities have uncommonly occurred during or shortly following perflutren- containing microsphere administration, typically within 30 minutes of administration. The risk may be increased among patients with unstable cardiopulmonary conditions such as acute myocardial infarction, acute coronary artery syndromes, worsening or unstable congestive heart failure, or serious ventricular arrhythmias. Always have cardiopulmonary resuscitation personnel and equipment readily available prior to perflutren administration and monitor all patients for acute reactions.

Serious cardiopulmonary reactions including fatalities have uncommonly occurred during or shortly following perflutren- containing microsphere administration, typically within 30 minutes of administration. The risk may be increased among patients with unstable cardiopulmonary conditions such as acute myocardial infarction, acute coronary artery syndromes, worsening or unstable congestive heart failure, or serious ventricular arrhythmias. Always have cardiopulmonary resuscitation personnel and equipment readily available prior to perflutren administration and monitor all patients for acute reactions.

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.

The pharmacokinetics of activated perflutren has not been studied in subjects with hepatic disease. Caution is advised if used in these patients.

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.