fluconazole
4 interactions related to fluconazole
fluconazole + grapefruit
Fluconazole is a moderate inhibitor of the liver enzyme CYP3A4, and grapefruit irreversibly inhibits intestinal CYP3A4. Their effects overlap on the same enzyme. On their own the pair rarely causes a problem, but together they can further slow the clearance of a third medication that also depends on CYP3A4, allowing its blood levels to rise.
probiotics + antifungals
Systemic antifungals (such as fluconazole, itraconazole, amphotericin B, and the echinocandins) can kill yeast-based probiotics such as Saccharomyces boulardii, blunting their benefit. Bacterial probiotics like Lactobacillus and Bifidobacterium are generally unaffected, because their cell structure differs from fungi.
saccharomyces boulardii + antifungals
Saccharomyces boulardii is a live yeast probiotic that is killed by systemic antifungals such as fluconazole, itraconazole, amphotericin B, and the echinocandins, so taking the two together cancels any probiotic benefit. More importantly, S. boulardii has caused documented bloodstream infections (fungemia), particularly in critically ill, immunocompromised, and catheterized patients, and those same antifungals are the drugs used to treat it.
fluconazole + warfarin
Fluconazole inhibits CYP2C9, the main enzyme that clears warfarin, so it can sharply raise warfarin's blood-thinning effect within a few days of starting, even after a single antifungal dose. Case reports document this combination causing serious and sometimes fatal bleeding.