▶Itraconazolepotentially increases the anticoagulant effect of
coumarins.rAnecdotal
▶Ketoconazolepotentially increases the anticoagulant effect of
coumarins(warfarin). Monitor INR and adjust dose.r
Anecdotal
▶Miconazolegreatly increases the anticoagulant effect of
coumarins. MHRA advises avoid unless INR can be monitored
closely; monitor for signs of bleeding.rStudy
▶Voriconazoleincreases the anticoagulant effect ofcoumarins.
Monitor INR and adjust dose.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to moderately increase the exposure tocrizotinib.
Avoid.oStudy→Also seeTABLE 9p. 849
▶Antifungals, azoles(itraconazole, ketoconazole)are predicted to
increase the exposure todabigatran. Avoid.rStudy
▶Isavuconazoleis predicted to increase the exposure to
dabigatran. Monitor and adjust dose.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure todabrafenib. Use with
caution or avoid.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to moderately increase the exposure todaclatasvir.
Adjustdaclatasvirdose.oStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to slightly increase the exposure todarifenacin.
oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to markedly to very markedly increase the exposure
todarifenacin. Avoid.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure todasatinib.r
Study→Also seeTABLE 9p. 849
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to markedly increase the exposure todasatinib.
Avoid.rStudy→Also seeTABLE 9p. 849
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)
very slightly increase the exposure todelamanid.r
Study→Also seeTABLE 9p. 849
▶Antifungals, azoles(fluconazole, voriconazole)moderately
increase the exposure todiazepam. Monitor and adjust dose.
oStudy
▶Didanosine(buffered) decreases the exposure toantifungals,
azoles(itraconazole, ketoconazole). Separate administration by
2 hours.rStudy→Also seeTABLE 1p. 847
▶Isavuconazoleslightly increases the exposure todigoxin.
Monitor and adjust dose.oStudy
▶Itraconazoleis predicted to markedly increase the
concentration ofdigoxin. Monitor and adjust dose.r
Study
▶Ketoconazoleis predicted to markedly increase the
concentration ofdigoxin.rStudy
▶Posaconazoleis predicted to increase the concentration of
digoxin.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, itraconazole,
ketoconazole, posaconazole, voriconazole)increase the risk of
QT-prolongation when given withdomperidone. Avoid.r
Study
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure todopamine receptor
agonists(bromocriptine).rTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)
increase the exposure todopamine receptor agonists
(bromocriptine).rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, itraconazole,
ketoconazole, posaconazole, voriconazole)are predicted to
increase the concentration ofdopamine receptor agonists
(cabergoline).oAnecdotal
▶Ketoconazolemoderately increases the exposure to
drospirenone.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to moderately increase the exposure to
dutasteride.nStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure todutasteride. Monitor
side effects and adjust dose.oTheoretical
▶Itraconazoleis predicted to slightly increase the exposure to
edoxaban.rTheoretical
▶Ketoconazoleslightly increases the exposure toedoxaban.
Adjustedoxabandose.rStudy
▶Efavirenzis predicted to decrease the exposure to
isavuconazole. Avoid.rTheoretical
▶Efavirenzslightly decreases the exposure toitraconazole.
Avoid and for 14 days after stoppingefavirenz.oStudy
▶Efavirenzmoderately decreases the exposure toketoconazole.
rStudy
▶Efavirenzslightly decreases the exposure toposaconazole.
Avoid.oStudy
▶Efavirenzmoderately decreases the exposure tovoriconazole
andvoriconazoleslightly increases the exposure toefavirenz.
Adjust dose.rStudy→Also seeTABLE 9p. 849
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)
slightly to moderately increase the exposure toelbasvir.
Avoid.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to markedly increase the exposure toeletriptan.
Avoid.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, itraconazole,
ketoconazole, posaconazole, voriconazole)are predicted to
increase the exposure toeliglustat. Avoid or adjust dose—
consult product literature.rStudy
▶Enzalutamideis predicted to decrease the exposure to
isavuconazole. Avoid.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the risk of ergotism when given with
ergometrine.rTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the risk of ergotism when given with
ergometrine. Avoid.rTheoretical
▶Miconazoleis predicted to increase the exposure to
ergometrine. Avoid.oTheoretical
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the risk of ergotism when given with
ergotamine.rTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the risk of ergotism when given with
ergotamine. Avoid.rTheoretical
▶Miconazoleis predicted to increase the exposure to
ergotamine. Avoid.oTheoretical
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toerlotinib.o
Theoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to slightly increase the exposure toerlotinib. Use
with caution and adjust dose.oStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the concentration ofeverolimus.
Avoid or adjust dose.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the concentration ofeverolimus. Avoid.
rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure tofesoterodine. Adjust
fesoterodinedose with moderate inhibitors of CYP3A4 in
hepatic and renal impairment.nStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to moderately increase the exposure tofesoterodine.
Adjustfesoterodinedose with potent inhibitors of CYP3A4;
avoid in hepatic and renal impairment.rStudy
▶Antifungals, azoles(itraconazole, ketoconazole)are predicted to
increase the exposure tofidaxomicin. Avoid.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure tofosaprepitant.o
Theoretical
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure togefitinib.o
Theoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure togefitinib.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole)potentially
increase the exposure toglecaprevir.oTheoreticalBNFC 2018 – 2019 Antifungals, azoles—Antifungals, azoles 873
Interactions|Appendix 1A1