Drug Interactions between fluconazole and primaquine

The use of primaquine is contraindicated in acutely ill patients suffering from systemic disease manifested by tendency to granulocytopenia, such as rheumatoid arthritis and lupus erythematosus. Primaquine has been reported to cause hematologic toxicity such as bone marrow depression, anemia, and leukopenia. Therapy with primaquine should be administered cautiously in patients with preexisting bone marrow depression or leukopenia. Since large doses of primaquine may increase the risk of leukopenia, the recommended dosage (15 mg base daily for 14 days in adults) should not be exceeded. Close monitoring is recommended if primaquine is prescribed to patients who have shown a previous idiosyncrasy to primaquine as manifested by leukopenia, hemolytic anemia, or methemoglobinemia. Blood cell counts should be performed regularly. Primaquine therapy should be discontinued immediately if there is a sudden decrease in leukocyte count.

Hemolysis, hemolytic anemia, and methemoglobinemia have been reported during use of primaquine in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency or nicotinamide adenine dinucleotide (NADH)-methemoglobin reductase deficiency. Therapy with primaquine should be administered cautiously in these patients. Since large doses of primaquine may increase the risk of hemolytic reactions, the recommended dosage (15 mg base daily for 14 days in adults) should not be exceeded. Close monitoring is recommended if primaquine is prescribed to patients who have shown a previous idiosyncrasy to primaquine or that have family or personal history of favism. Blood cell counts and hemoglobin determinations should be performed regularly. Primaquine therapy should be discontinued immediately if signs suggestive of hemolytic anemia occur, such as marked darkening of the urine or sudden decrease in hemoglobin concentration or erythrocytic count.

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 Treatment should be withdrawn if persistent elevations or worsening of liver enzyme levels occur.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 primaquine is contraindicated in acutely ill patients suffering from systemic disease manifested by tendency to granulocytopenia, such as rheumatoid arthritis and lupus erythematosus. Primaquine has been reported to cause hematologic toxicity such as bone marrow depression, anemia, and leukopenia. Therapy with primaquine should be administered cautiously in patients with preexisting bone marrow depression or leukopenia. Since large doses of primaquine may increase the risk of leukopenia, the recommended dosage (15 mg base daily for 14 days in adults) should not be exceeded. Close monitoring is recommended if primaquine is prescribed to patients who have shown a previous idiosyncrasy to primaquine as manifested by leukopenia, hemolytic anemia, or methemoglobinemia. Blood cell counts should be performed regularly. Primaquine therapy should be discontinued immediately if there is a sudden decrease in leukocyte count.

Hemolysis, hemolytic anemia, and methemoglobinemia have been reported during use of primaquine in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency or nicotinamide adenine dinucleotide (NADH)-methemoglobin reductase deficiency. Therapy with primaquine should be administered cautiously in these patients. Since large doses of primaquine may increase the risk of hemolytic reactions, the recommended dosage (15 mg base daily for 14 days in adults) should not be exceeded. Close monitoring is recommended if primaquine is prescribed to patients who have shown a previous idiosyncrasy to primaquine or that have family or personal history of favism. Blood cell counts and hemoglobin determinations should be performed regularly. Primaquine therapy should be discontinued immediately if signs suggestive of hemolytic anemia occur, such as marked darkening of the urine or sudden decrease in hemoglobin concentration or erythrocytic count.

The use of primaquine is contraindicated in acutely ill patients suffering from systemic disease manifested by tendency to granulocytopenia, such as rheumatoid arthritis and lupus erythematosus. Primaquine has been reported to cause hematologic toxicity such as bone marrow depression, anemia, and leukopenia. Therapy with primaquine should be administered cautiously in patients with preexisting bone marrow depression or leukopenia. Since large doses of primaquine may increase the risk of leukopenia, the recommended dosage (15 mg base daily for 14 days in adults) should not be exceeded. Close monitoring is recommended if primaquine is prescribed to patients who have shown a previous idiosyncrasy to primaquine as manifested by leukopenia, hemolytic anemia, or methemoglobinemia. Blood cell counts should be performed regularly. Primaquine therapy should be discontinued immediately if there is a sudden decrease in leukocyte count.

The use of primaquine is contraindicated in acutely ill patients suffering from systemic disease manifested by tendency to granulocytopenia, such as rheumatoid arthritis and lupus erythematosus. Primaquine has been reported to cause hematologic toxicity such as bone marrow depression, anemia, and leukopenia. Therapy with primaquine should be administered cautiously in patients with preexisting bone marrow depression or leukopenia. Since large doses of primaquine may increase the risk of leukopenia, the recommended dosage (15 mg base daily for 14 days in adults) should not be exceeded. Close monitoring is recommended if primaquine is prescribed to patients who have shown a previous idiosyncrasy to primaquine as manifested by leukopenia, hemolytic anemia, or methemoglobinemia. Blood cell counts should be performed regularly. Primaquine therapy should be discontinued immediately if there is a sudden decrease in leukocyte count.

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.