Fluconazole with Vinblastine Interaction Details
Brand Names Associated with Fluconazole
- Diflucan®
- Fluconazole
Brand Names Associated with Vinblastine
- Velban®
- Vinblastine
- Vincaleukoblastine Sulfate
- VLB
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 27, 2023
Interaction Effect
Increased vinca alkaloid exposure and an increased risk of neurotoxicity
Interaction Summary
Concomitant administration of fluconazole with vinca alkaloids may increase the plasma levels of the vinca alkaloids and lead to neurotoxicity, which is possibly due to an inhibitory effect on CYP3A4.The enzyme inhibiting effect of fluconazole persists for 4 to 5 days following fluconazole discontinuation . In a retrospective study (n=50) of adult patients with acute lymphoblastic leukemia receiving vincristine-based therapy with or without voriconazole treatment or posaconazole/fluconazole prophylaxis, an increased incidence of toxicity (decreased peristalsis) and vinCRIStine dosing adjustments (dose reductions, delay, or discontinuation) was noted for patients receiving azole therapy compared with patients not receiving azoles. Use caution if these agents are administered concurrently .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant administration of fluconazole with vinca alkaloids may increase the plasma levels of the vinca alkaloids and lead to neurotoxicity, which is possibly due to an inhibitory effect on CYP3A4. The enzyme inhibiting effect of fluconazole persists for 4 to 5 days following fluconazole discontinuation . Use caution if vinCRIStine and fluconazole are administered concurrently .
Mechanism Of Interaction
Inhibition of CYP3A4-mediated metabolism by fluconazole
Literature Reports
A) An increased incidence of toxicity (decreased peristalsis) occurred in adults with acute lymphoblastic leukemia who received vinCRIStine-based therapy with or without voriconazole or posaconazole/fluconazole (all are moderate or strong CYP3A inhibitors) prophylaxis in a retrospective study (n=50). Dose reduction, delay, or discontinuation was noted for patients who received azole therapy compared with patients who did not receive azoles .
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.
Vinblastine Overview
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Vinblastine is used in combination with other chemotherapy drugs to treat Hodgkin's lymphoma (Hodgkin's disease) and non-Hodgkin's lymphoma (types of cancer that begin in a type of white blood cell that normally fights infection), and cancer of the testicles. It is also used to treat Langerhans cell histiocytosis (histiocytosis X; Letterer-Siwe disease; a condition in which too many of a certain type of white blood cell grows in parts of the body). It may also be used to treat breast cancer that has not improved after treatment with other medications and gestational trophoblastic tumors (a type of tumor that forms inside a woman's uterus while she is pregnant) that has not improved after surgery or treatment with other medications. Vinblastine is in a class of medications called vinca alkaloids. It works by slowing or stopping the growth of cancer cells in your body.
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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.