Fluconazole with Prednisone Interaction Details

Brand Names Associated with Fluconazole

Brand Names Associated with Prednisone

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 27, 2023

Interaction Effect

A decrease in the metabolic degradation of predniSONE and an increase in predniSONE efficacy

Interaction Summary

Patients on long-term treatment with fluconazole and prednisone should be carefully monitored for adrenal cortex insufficiency when fluconazole is discontinued. A liver transplant recipient receiving predniSONE experienced an Addisonian crisis when a three-month course of fluconazole was discontinued. Fluconazole is a potent inhibitor of CYP3A4 enzymes which degrade glucocorticoids. The withdrawal of fluconazole caused an increase in CYP3A4 activity, leading to an increase in the degradation of predniSONE and the precipitation of an Addisonian crisis .

Severity

Moderate

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Patients receiving long-term therapy with fluconazole and predniSONE should be closely monitored for signs of adrenal insufficiency if fluconazole is discontinued.

Mechanism Of Interaction

Inhibition of CYP3A4-mediated predniSONE metabolism by fluconazole

Literature Reports

A) A 50-year-old female who had undergone a liver transplant was receiving a maintenance dose of predniSONE 10 mg daily and a three-month course of fluconazole . Five days following the discontinuation of fluconazole, the patient complained of fatigue, dizziness, and was noted to have orthostatic hypotension. Her symptoms persisted despite intravenous hydration, and one day later her electrolyte panel demonstrated marked abnormalities. Interestingly, the patient also experienced a substantial decrease in her cyclosporine levels, such that her daily dose of cyclosporine had to be doubled over the next five days to stabilize her levels. Hydrocortisone 100 mg and fludrocortisone 0.1 mg corrected her symptoms and abnormal electrolyte values . This patient was in a state of secondary adrenal insufficiency due to an immunosuppressive dose of predniSONE. When fluconazole was discontinued, CYP3A4 inhibition was reversed, which is hypothesized to have increased the degradation of predniSONE and resulted in an Addisonian crisis .

Fluconazole Overview

• 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.

Prednisone Overview

• Prednisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Prednisone is also used to treat other conditions in patients with normal corticosteroid levels. These conditions include certain types of arthritis; severe allergic reactions; multiple sclerosis (a disease in which the nerves do not function properly); lupus (a disease in which the body attacks many of its own organs); and certain conditions that affect the lungs, skin, eyes, kidneys blood, thyroid, stomach, and intestines. Prednisone is also sometimes used to treat the symptoms of certain types of cancer. Prednisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.