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Study

▶ Miconazole is predicted to increase the concentration of

reboxetine

Theoretical

. Use with caution and adjust dose.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

o

regorafenib. Avoid.

Study

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

Study

repaglinide.o ▶ Antifungals, azoles (fluconazole, itraconazole, ketoconazole,

miconazole, voriconazole) are predicted to increase the

exposure to retinoids (alitretinoin). Adjust alitretinoin dose,

p. 1262.oTheoretical

▶ Antifungals, azoles (fluconazole, ketoconazole, voriconazole) are

predicted to increase the risk of tretinoin toxicity when given

with retinoids (tretinoin).oStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Study → Also see TABLE 9 p. 1377

ribociclib.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to ribociclib. Avoid or

adjust ribociclib dose, p. 997.oStudy → Also see TABLE 9

p. 1377

▶ Antifungals, azoles (itraconazole, posaconazole) increase the

concentration of rifabutin and rifabutin decreases the

concentration of antifungals, azoles (itraconazole,

posaconazole). Avoid.rStudy

▶ Fluconazole increases the risk of uveitis when given with

rifabutin. Adjust dose.rStudy

▶ Rifabutin is predicted to decrease the exposure to

isavuconazole. Avoid.rTheoretical

▶ Ketoconazole is predicted to increase the concentration of

rifabutin and rifabutin is predicted to decrease the

concentration of ketoconazole. Avoid.rTheoretical

▶ Miconazole is predicted to increase the concentration of

rifabutin

Theoretical

. Use with caution and adjust dose.o ▶ Rifabutin decreases the concentration of voriconazole and

voriconazole increases the concentration of rifabutin. Avoid or

adjust voriconazole dose, p. 599.rStudy

▶ Rifampicin slightly decreases the exposure to fluconazole.

Adjust dose.oStudy

▶ Rifampicin is predicted to decrease the exposure to

isavuconazole. Avoid.rStudy

▶ Rifampicin markedly decreases the exposure to itraconazole.

Avoid and for 14 days after stopping rifampicin.oStudy

▶ Rifampicin markedly decreases the exposure to ketoconazole

and ketoconazole potentially decreases the exposure to

rifampicin. Avoid.oStudy

▶ Rifampicin is predicted to decrease the exposure to

posaconazole. Avoid.oAnecdotal

▶ Rifampicin very markedly decreases the exposure to

voriconazole. Avoid.oStudy

▶ Itraconazole is predicted to increase the exposure to riociguat.

Avoid.oStudy

▶ Ketoconazole moderately increases the exposure to riociguat.

Avoid.oStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

o

risperidone. Adjust dose.

Study → Also see TABLE 9 p. 1377

▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to

moderately increase the exposure to

r

rivaroxaban. Avoid.

Study

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical

ruxolitinib.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to ruxolitinib. Adjust dose

and monitor side effects.oStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to saxagliptin.n

Study

BNF 78 Antifungals, azoles — Antifungals, azoles 1405

Interactions | Appendix 1

A1

Antifungals, azoles (continued)

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

Study

saxagliptin.o ▶ Fluconazole

q

is predicted to increase the exposure to selexipag.

Theoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

increase the concentration of sirolimus. Monitor and adjust

dose.oStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the concentration of

r

sirolimus. Avoid.

Study

▶ Miconazole is predicted to increase the concentration of

sirolimus. Monitor and adjust dose.oStudy

▶ Oral sodium bicarbonate decreases the absorption of

ketoconazole.oStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to solifenacin. Adjust

solifenacin p. 779 or tamsulosin with solifenacin p. 786 dose;

avoid in hepatic and renal impairment.rStudy

▶ Voriconazole is predicted to increase the exposure to SSRIs

(citalopram).rTheoretical → Also see TABLE 9 p. 1377

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to SSRIs (dapoxetine).

Adjust dapoxetine dose with moderate inhibitors of CYP3A4,

p. 821.oTheoretical

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to moderately increase the exposure to SSRIs

(dapoxetine). Avoid potent inhibitors of CYP3A4 or adjust

dapoxetine dose, p. 821.rStudy

▶ St John’s Wort is predicted to decrease the exposure to

isavuconazole. Avoid.rTheoretical

▶ St John’s Wort moderately decreases the exposure to

voriconazole. Avoid.oStudy

▶ Miconazole potentially increases the exposure to statins

(atorvastatin).rAnecdotal

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to statins (atorvastatin).

Monitor and adjust dose.rStudy → Also see TABLE 1 p. 1375

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to statins (atorvastatin).

Avoid or adjust dose and monitor rhabdomyolysis.

Study → Also see TABLE 1 p. 1375

r

▶ Antifungals, azoles (fluconazole, miconazole) are predicted to

increase the exposure to

Theoretical → Also see TABLE 1

statins

p. 1375

(fluvastatin).r

▶ Isavuconazole is predicted to increase the exposure to statins

(fluvastatin, rosuvastatin).oTheoretical

▶ Miconazole is predicted to increase the exposure to statins

(simvastatin). Avoid.rTheoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to statins (simvastatin).

Use with caution and adjust

Study → Also see TABLE 1 p. 1375

simvastatin dose, p. 205.r

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to statins (simvastatin).

Avoid.rStudy → Also see TABLE 1 p. 1375

▶ Isavuconazole is predicted to increase the exposure to

sulfasalazine.oTheoretical

▶ Antifungals, azoles (fluconazole, miconazole) are predicted to

increase the exposure to sulfonylureas. Use with caution and

adjust dose.oStudy

▶ Voriconazole is predicted to increase the concentration of

sulfonylureas

Study

. Use with caution and adjust dose.o ▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical → Also see TABLE 9 p. 1377

sunitinib.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to slightly increase the exposure to sunitinib. Avoid

or adjust sunitinib dose, p. 999.oStudy → Also see TABLE 9

p. 1377

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the concentration of

r

tacrolimus.

Study

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the concentration of tacrolimus. Monitor

and adjust dose.rStudy

▶ Miconazole is predicted to increase the concentration of

tacrolimus. Monitor and adjust dose.rTheoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

o taxanes (cabazitaxel).

Theoretical

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to taxanes (cabazitaxel).

Avoid.rStudy

▶ Miconazole is predicted to increase the concentration of

taxanes

o

(docetaxel). Use with caution and adjust dose.

Theoretical

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to moderately increase the exposure to taxanes

(docetaxel). Avoid or adjust dose.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

r taxanes (paclitaxel).

Theoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the concentration of

o

temsirolimus.

Theoretical

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the concentration of temsirolimus.

Avoid.rTheoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to tezacaftor. Adjust

tezacaftor with ivacaftor p. 295 dose with moderate inhibitors

of CYP3A4.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to tezacaftor. Adjust

tezacaftor with ivacaftor p. 295 dose with potent inhibitors of

CYP3A4.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to markedly increase the exposure to ticagrelor.

Avoid.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

given with a potent CYP2C19 inhibitor are predicted to

increase the exposure to tofacitinib. Adjust tofacitinib dose,

p. 1105.oStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to tofacitinib. Adjust

tofacitinib dose, p. 1105.oStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to tolterodine.n Theoretical → Also see TABLE 9 p. 1377

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

r

tolterodine. Avoid.

Study → Also see TABLE 9 p. 1377

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to tolvaptan.

Manufacturer advises caution or adjust tolvaptan dose with

moderate inhibitors of CYP3A4, p. 669.oStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to tolvaptan. Manufacturer

advises caution or adjust tolvaptan dose with potent inhibitors

of CYP3A4, p. 669.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to

increase the exposure to topotecan.rStudy

▶ Isavuconazole is predicted to increase the exposure to

topotecan.oTheoretical

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

Theoretical → Also see TABLE 9 p. 1377

toremifene.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to trabectedin. Avoid or

adjust dose.rTheoretical → Also see TABLE 1 p. 1375

▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to

increase the concentration of trametinib.oTheoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical

trazodone.o

1406 Antifungals, azoles — Antifungals, azoles BNF 78

Interactions | Appendix 1

A1

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to moderately increase the exposure to trazodone.

Avoid or adjust dose.oStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to ulipristal. Avoid if

used for uterine fibroids.oStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to ulipristal. Avoid if used

for uterine fibroids.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

Theoretical → Also see TABLE 9 p. 1377

vemurafenib.r

▶ Antifungals, azoles (fluconazole, isavuconazole, itraconazole,

ketoconazole, posaconazole, voriconazole) are predicted to

increase the exposure to venetoclax. Avoid or adjust dose—

consult product literature.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

Study → Also see TABLE 9 p. 1377

venlafaxine.o ▶ Antifungals, azoles (fluconazole, isavuconazole, itraconazole,

ketoconazole, posaconazole, voriconazole) are predicted to

increase the exposure to vinca alkaloids.rTheoretical →

Also see TABLE 1 p. 1375 → Also see TABLE 9 p. 1377

▶ Miconazole is predicted to increase the concentration of vinca

alkaloids

Theoretical

. Use with caution and adjust dose.o ▶ Antifungals, azoles (clotrimazole, ketoconazole) are predicted to

decrease the exposure to

o

vitamin D substances (colecalciferol).

Theoretical

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to vitamin D substances

(paricalcitol).oStudy

▶ Fluconazole

o

slightly increases the exposure to zidovudine.

Study

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to zopiclone. Adjust

dose.oStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

o

zopiclone. Adjust dose.

Theoretical

Antihistamines, non-sedating → see TABLE 9 p. 1377 (QT-interval

prologation)

acrivastine . azelastine . bilastine . cetirizine . desloratadine . fexofenadine . levocetirizine . loratadine . mizolastine .rupatadine.

▶ Since systemic absorption can follow topical application,

the possibility of interactions with topical azelastine

should be borne in mind.

▶ Apple juice and orange juice decrease the exposure to

fexofenadine.

▶ Antacids decrease the absorption of fexofenadine. Separate

administration by 2 hours.nStudy

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to rupatadine. Avoid.oStudy

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to antihistamines, non-sedating (fexofenadine,

mizolastine).rTheoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, itraconazole,

ketoconazole, posaconazole, voriconazole) are predicted to

increase the exposure to rupatadine. Avoid.oStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical

mizolastine.r

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

r

mizolastine. Avoid.

Study

▶ Antifungals, azoles (miconazole) are predicted to increase the

exposure to mizolastine. Avoid.oTheoretical

▶ Apalutamide slightly decreases the exposure to fexofenadine.

nStudy

▶ Aprepitant

r

is predicted to increase the exposure to mizolastine.

Theoretical

▶ Aprepitant is predicted to increase the exposure to rupatadine.

Avoid.oStudy

▶ Antihistamines, non-sedating are predicted to decrease the

effects of betahistine.oTheoretical

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to mizolastine.rTheoretical

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to rupatadine. Avoid.oStudy

▶ Ceritinib

o

is predicted to increase the exposure to fexofenadine.

Theoretical

▶ Cobicistat is predicted to increase the exposure to mizolastine.

Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to rupatadine.

Avoid.oStudy

▶ Crizotinib

r

is predicted to increase the exposure to mizolastine.

Theoretical

▶ Crizotinib is predicted to increase the exposure to rupatadine.

Avoid.oStudy

▶ Eliglustat is predicted to increase the exposure to

fexofenadine. Adjust dose.oStudy

▶ Grapefruit juice slightly decreases the exposure to bilastine.

Bilastine should be taken 1 hour before or 2 hours after

grapefruit juice.oStudy

▶ Grapefruit juice

o

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