fluconazole
4 interactions related to fluconazole
fluconazole + grapefruit
Fluconazole is a moderate inhibitor of CYP3A4 and grapefruit juice inhibits intestinal CYP3A4; the inhibition is additive, which can raise plasma levels of any third drug that depends on CYP3A4 for clearance.
probiotics + antifungals
Systemic antifungals (fluconazole, itraconazole, amphotericin B, echinocandins) can kill yeast-based probiotics such as Saccharomyces boulardii, reducing their effectiveness. Bacterial probiotics like Lactobacillus and Bifidobacterium are generally unaffected by azole antifungals because their cell structures differ from fungi.
saccharomyces boulardii + antifungals
Saccharomyces boulardii is a live yeast that is directly susceptible to systemic antifungals such as fluconazole, itraconazole, amphotericin B, and echinocandins, which kill the probiotic and negate its benefit. The same antifungals may be required to treat S. boulardii fungemia, a documented complication in critically ill and immunocompromised patients.
fluconazole + warfarin
Fluconazole inhibits CYP2C9 and CYP3A4, the enzymes that clear warfarin, and can rapidly raise INR by 50 to 100 percent or more within two to three days of starting, with documented cases of major bleeding and death.