▶Antacidsdecrease the absorption ofitraconazole(capsule).
Antacidsshould be taken 1 hour before or 2 hours after
itraconazole.oStudy
▶Antacidsdecrease the absorption ofketoconazole. Separate
administration by at least 2 hours.oStudy
▶Miconazoleis predicted to increase the exposure to
antiarrhythmics(disopyramide). Use with caution and adjust
dose.rTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toantiarrhythmics
(disopyramide). Avoid.rTheoretical→Also seeTABLE 9
p. 849
▶Posaconazoleis predicted to increase the exposure to
antiarrhythmics(disopyramide, dronedarone). Avoid.r
Theoretical
▶Fluconazoleis predicted to increase the exposure to
antiarrhythmics(dronedarone).rTheoretical→Also see
TABLE 9p. 849
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)
very markedly increase the exposure toantiarrhythmics
(dronedarone). Avoid.rStudy→Also seeTABLE 9p. 849
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toantiarrhythmics
(propafenone). Monitor and adjust dose.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toantiarrhythmics
(propafenone). Monitor and adjust dose.rStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toanticholinesterases,
centrally acting(galantamine). Monitor and adjust dose.
oStudy
▶Antiepileptics(carbamazepine)are predicted to decrease the
efficacy offluconazoleandfluconazoleincreases the
concentration ofantiepileptics(carbamazepine). Avoid or
monitorcarbamazepineconcentration and adjust dose
accordingly.rTheoretical→Also seeTABLE 1p. 847
▶Antiepileptics(carbamazepine)are predicted to decrease the
efficacy ofketoconazoleandketoconazoleslightly increases
the concentration ofantiepileptics(carbamazepine). Avoid or
monitorcarbamazepineconcentration and adjust dose
accordingly.oStudy
▶Antiepileptics(carbamazepine)are predicted to decrease the
efficacy ofposaconazoleandposaconazoleincreases the
concentration ofantiepileptics(carbamazepine). Avoid.
oTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toisavuconazole. Avoid.rStudy
▶Antiepileptics(fosphenytoin)very markedly decrease the
exposure toitraconazole. Avoid and for 14 days after stopping
fosphenytoin.oStudy
▶Antiepileptics(fosphenytoin)decrease the exposure to
voriconazoleandvoriconazoleincreases the exposure to
antiepileptics(fosphenytoin). Avoid or adjustvoriconazoledose
p. 377and monitor phenytoin concentration.oStudy
▶Antiepileptics(fosphenytoin, phenytoin)decrease the exposure
toketoconazole. Avoid.oStudy
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to
decrease the exposure toposaconazole. Avoid.oStudy
▶Antiepileptics(phenobarbital)decrease the concentration of
itraconazole. Avoid and for 14 days after stopping
phenobarbital.oStudy
▶Antiepileptics(phenobarbital)are predicted to decrease the
concentration ofketoconazole. Avoid.oStudy
▶Antiepileptics(phenobarbital)are predicted to decrease the
concentration ofposaconazole. Avoid.oStudy
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the concentration ofvoriconazole. Avoid.o
Theoretical
▶Antiepileptics(phenytoin)very markedly decrease the exposure
toitraconazole. Avoid and for 14 days after stopping
phenytoin.oStudy
▶Antiepileptics(phenytoin)decrease the exposure tovoriconazole
andvoriconazoleincreases the exposure toantiepileptics
(phenytoin). Avoid or adjustvoriconazoledosep. 377and
monitorphenytoinconcentration.oStudy
▶Antiepileptics(primidone)are predicted to decrease the
concentration ofitraconazole.oTheoretical
▶Miconazoleincreases the risk of carbamazepine toxicity when
given withantiepileptics(carbamazepine). Monitor and adjust
dose.rAnecdotal
▶Miconazoleincreases the risk of phenytoin toxicity when given
withantiepileptics(fosphenytoin). Monitor and adjust dose.
rAnecdotal
▶Fluconazoleincreases the concentration ofantiepileptics
(fosphenytoin, phenytoin). Monitor concentration and adjust
dose.oStudy
▶Antiepileptics(carbamazepine)are predicted to decrease the
efficacy ofantifungals, azoles(itraconazole, voriconazole)and
antifungals, azoles(itraconazole, voriconazole)increase the
concentration ofantiepileptics(carbamazepine). Avoid or
adjust dose.oTheoretical→Also seeTABLE 1p. 847
▶Antiepileptics(primidone)are predicted to decrease the
concentration ofantifungals, azoles(ketoconazole,
posaconazole). Avoid.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to very slightly increase the exposure to
antiepileptics(perampanel).nStudy
▶Miconazoleincreases the risk of phenytoin toxicity when given
withantiepileptics(phenytoin). Monitor and adjust dose.r
Anecdotal
▶Antifungals, azoles(fluconazole)are predicted to increase the
exposure toantifungals, azoles(isavuconazole).rTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toantifungals, azoles
(isavuconazole). Avoid or monitor side effects.rStudy
▶Antifungals, azoles(posaconazole)are predicted to increase the
exposure toantifungals, azoles(isavuconazole).o
Theoretical
▶Miconazoleis predicted to increase the exposure to
antihistamines, non-sedating(mizolastine). Avoid.o
Theoretical
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toantihistamines, non-
sedating(mizolastine).rTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toantihistamines, non-
sedating(mizolastine). Avoid.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, itraconazole,
ketoconazole, posaconazole, voriconazole)are predicted to
increase the exposure toantihistamines, non-sedating
(rupatadine). Avoid.oStudy
▶Ketoconazoleincreases the exposure toantimalarials
(mefloquine).oStudy
▶Antifungals, azoles(fluconazole, itraconazole, posaconazole,
voriconazole)are predicted to increase the exposure to
antimalarials(mefloquine).oTheoretical
▶Antifungals, azoles(fluconazole, isavuconazole, itraconazole,
ketoconazole, posaconazole, voriconazole)are predicted to
increase the concentration ofantimalarials(piperaquine).
rTheoretical
▶Itraconazoleis predicted to increase the exposure toapixaban.
Avoid.rTheoretical
▶Ketoconazoleslightly to moderately increases the exposure to
apixaban. Avoid.rStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to markedly increase the exposure toaprepitant.
oStudy
▶Aprepitantis predicted to increase the exposure to
isavuconazole.oTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to slightly increase the exposure toaripiprazole.
Adjustaripiprazoledose,p. 249.oStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toaxitinib.o
Theoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toaxitinib. Avoid or adjust
dose.oStudyBNFC 2018 – 2019 Antifungals, azoles—Antifungals, azoles 871
Interactions|Appendix 1A1