Fluconazole with Nevirapine Interaction Details
Brand Names Associated with Fluconazole
- Diflucan®
- Fluconazole
Brand Names Associated with Nevirapine
- Nevirapine
- Viramune®
- Viramune® XR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 27, 2023
Interaction Effect
Increased nevirapine exposure
Interaction Summary
Coadministration of nevirapine and fluconazole has resulted in an approximate 100% increase in nevirapine exposure. In a study of HIV-infected patients, nevirapine exposure (AUC (0 to 8 hr)) was increased by 29% in those receiving a nevirapine-containing regimen plus fluconazole. Despite the significant increase in nevirapine exposure, there was no evidence of increased nevirapine toxicity . Caution should be used when fluconazole and nevirapine are coadministered and patients should be monitored closely for nevirapine toxicity .
Severity
Major
Onset
Rapid
Evidence
Established
How To Manage Interaction
Concomitant use of fluconazole and nevirapine has resulted in increased nevirapine exposure. Therefore, caution should be used when these drugs are coadministered and patients should be monitored closely for nevirapine-associated adverse effects .
Mechanism Of Interaction
Unknown
Literature Reports
A) Concomitant use of fluconazole and nevirapine significantly increased nevirapine exposure in a subset of HIV-infected Uganda patients (n=49) from a placebo-controlled study. Patients were treated with an antiretroviral regimen, that contained nevirapine (200 mg twice daily), plus either fluconazole (n=27) or placebo (n=22) for a median of 55 weeks (range, 48 to 68 weeks). The fluconazole and placebo groups had geometric mean pre-dose nevirapine concentrations of 5141 nanogram/mL (ng/mL; 19,305 mcmol/L) and 3865 ng/mL (14,513 mcmol/L), respectively. Nevirapine Cmax was also higher with fluconazole (p=0.012). The nevirapine AUC (0 to 8 hr) was increased by 29% in the fluconazole group (geometric mean AUC, 46,135 ng x hr/mL vs 35,871 ng x hr/mL ). The nevirapine concentration at 8 hr was increased by 28% with concomitant fluconazole (p=0.02). Nevirapine clearance decreased with fluconazole (5.58 L/hr vs 4.34 L/hr; p=0.0172). There was no evidence of increased risk of hepatotoxicity with concomitant use of nevirapine and fluconazole despite the increased nevirapine exposure. In the study from which the subset was taken, elevated transaminases (greater than 5 times the ULN) resulted in trial withdrawal in 5.2% (27 of 522) and 6.3% (34 of 541) of patients being treated with fluconazole and placebo, respectively. A total of 1.3% (14 of 1063) had liver function tests greater than 5 times the ULN in the initial 6 to 12 weeks. Of these 14 patients, 5 and 9 received fluconazole and placebo, respectively (p=0.42) .
Fluconazole Overview
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Fluconazole is used to treat fungal infections, including yeast infections of the vagina, mouth, throat, esophagus (tube leading from the mouth to the stomach), abdomen (area between the chest and waist), lungs, blood, and other organs. Fluconazole is also used to treat meningitis (infection of the membranes covering the brain and spine) caused by fungus. Fluconazole is also used to prevent yeast infections in patients who are likely to become infected because they are being treated with chemotherapy or radiation therapy before a bone marrow transplant (replacement of unhealthy spongy tissue inside the bones with healthy tissue). Fluconazole is in a class of antifungals called triazoles. It works by slowing the growth of fungi that cause infection.
Nevirapine Overview
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Nevirapine is used along with other medications to treat human immunodeficiency virus (HIV) infection in adults and children 15 days of age and older. Nevirapine should not be used to treat healthcare workers or other individuals exposed to HIV infection after contact with HIV-contaminated blood, tissues, or other body fluids. Nevirapine is in a class of medications called non-nucleoside reverse transcriptase inhibitors (NNRTIs). It works by decreasing the amount of HIV in the blood. Although nevirapine does not cure HIV, it may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Taking these medications along with practicing safer sex and making other life-style changes may decrease the risk of transmitting (spreading) the HIV virus to other people.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.