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Ketoconazole and fluconazole drug interactions
1Department of Pharmacy Services, University Hospitals of Cleveland, Ohio.
Archives of Internal Medicine
|September 13, 1993
Summary
This review examines drug interactions with ketoconazole and fluconazole. Ketoconazole may alter dosages of other medications due to enzyme inhibition, while fluconazole appears to pose fewer risks.
Area of Science:
- Pharmacology
- Drug Metabolism
- Clinical Pharmacy
Background:
- Antifungal agents ketoconazole and fluconazole are widely used.
- Understanding their potential drug interactions is crucial for patient safety.
- Hepatic enzyme systems play a key role in drug metabolism.
Purpose of the Study:
- To review and summarize known drug interactions involving ketoconazole and fluconazole.
- To identify drugs whose dosages may need adjustment when co-administered with these antifungals.
- To compare the interaction potential of ketoconazole versus fluconazole.
Main Methods:
- Literature review of English-language data sources.
- Analysis of computerized databases and published indexes.
- Inclusion of case reports and relevant studies.
Main Results:
- Ketoconazole and fluconazole may decrease dosage requirements for cyclosporine, methylprednisolone, anticoagulants, and phenytoin, indicating hepatic enzyme inhibition.
- Rifampin increases ketoconazole dosage requirements, suggesting hepatic microsomal enzyme induction.
- Potential interactions between rifampin and fluconazole require further investigation.
Conclusions:
- Ketoconazole exhibits a higher potential for drug interactions compared to fluconazole.
- Fluconazole's selectivity for fungal P-450 enzymes may reduce its clinical interaction risk.
- Further research is needed on ketoconazole's effects on prednisolone and theophylline.