Antifungals, Azole (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the azole antifungals, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to any of the azole antifungals. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy - Studies have not been done in pregnant women. However, studies in some animals have shown that azole antifungals, taken in high doses, may cause harm to the mother and the fetus. They have caused birth defects in animals. Before taking these medicines, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding - Azole antifungals pass into breast milk. Mothers who are taking these medicines and who wish to breast-feed should discuss this with their doctors.

Children - A small number of children have been safely treated with azole antifungals. Be sure to discuss with your child's doctor the use of these medicines in children.

Older adults - Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of azole antifungals in the elderly with use in other age groups.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking azole antifungals, it is especially important that your health care professional know if you are taking any of the following:

• Acetaminophen (e.g., Tylenol) (with long-term, high-dose use) or
• Amiodarone (e.g., Cordarone) or
• Anabolic steroids (nandrolone [e.g., Anabolin], oxandrolone [e.g., Anavar], oxymetholone [e.g., Anadrol], stanozolol [e.g., Winstrol]) or
• Androgens (male hormones) or
• Antithyroid agents (medicine for overactive thyroid) or
• Carmustine (e.g., BiCNU) or
• Chloroquine (e.g., Aralen) or
• Dantrolene (e.g., Dantrium) or
• Daunorubicin (e.g., Cerubidine) or
• Disulfiram (e.g., Antabuse) or
• Divalproex (e.g., Depakote) or
• Estrogens (female hormones) or
• Etretinate (e.g., Tegison) or
• Gold salts (medicine for arthritis) or
• Hydroxychloroquine (e.g., Plaquenil) or
• Mercaptopurine (e.g., Purinethol) or
• Methotrexate (e.g., Mexate) or
• Methyldopa (e.g., Aldomet) or
• Naltrexone (e.g., Trexan) (with long-term, high-dose use) or
• Oral contraceptives (birth control pills) containing estrogen or
• Other anti-infectives by mouth or by injection (medicine for infection) or
• Phenothiazines (acetophenazine [e.g., Tindal], chlorpromazine [e.g., Thorazine], fluphenazine [e.g., Prolixin], mesoridazine [e.g., Serentil], perphenazine [e.g., Trilafon], prochlorperazine [e.g., Compazine], promazine [e.g., Sparine], promethazine [e.g., Phenergan], thioridazine [e.g., Mellaril], trifluoperazine [e.g., Stelazine], triflupromazine [e.g., Vesprin], trimeprazine [e.g., Temaril]) or
• Plicamycin (e.g., Mithracin) or
• Valproic acid (e.g., Depakene) - Use of these medicines with azole antifungals may increase the chance of side effects affecting the liver

• Alprazolam (e.g., Xanax) or
• Diazepam (e.g., Valium) or
• Midazolam (e.g., Versed) or
• Triazolam (e.g., Halcion) - Sedative effects are increased when taken with itraconazole or ketoconazole.

• Amantadine (e.g., Symmetrel) or
• Antacids or
• Anticholinergics (medicine for abdominal or stomach spasms or cramps) or
• Antidepressants (medicine for depression) or
• Antidyskinetics (medicine for Parkinson's disease or other conditions affecting control of muscles) or
• Antihistamines or
• Antipsychotics (medicine for mental illness) or
• Buclizine (e.g., Bucladin) or
• Cimetidine (e.g., Tagamet) or
• Cyclizine (e.g., Marezine) or
• Cyclobenzaprine (e.g., Flexeril) or
• Disopyramide (e.g., Norpace) or
• Famotidine (e.g., Pepcid) or
• Flavoxate (e.g., Urispas) or
• Ipratropium (e.g., Atrovent) or
• Meclizine (e.g., Antivert) or
• Methylphenidate (e.g., Ritalin) or
• Nizatidine (e.g., Axid) or
• Omeprazole (e.g., Prilosec) or
• Orphenadrine (e.g., Norflex) or
• Oxybutynin (e.g., Ditropan) or
• Procainamide (e.g., Pronestyl) or
• Promethazine (e.g., Phenergan) or
• Quinidine (e.g., Quinidex) or
• Ranitidine (e.g., Zantac) or
• Sucralfate (e.g., Carafate) or
• Trimeprazine (e.g., Temaril) - Use of these medicines may decrease the effects of itraconazole and ketoconazole; these medicines should be taken at least 2 hours after itraconazole or ketoconazole

• Antidiabetic agents, oral (chlorpropamide [e.g., Diabinese], glipizide [e.g., Glucotrol], glyburide [e.g., DiaBeta, Micronase], tolbutamide [e.g., Orinase]) or

• Astemizole (e.g., Hismanal) or
• Terfenadine (e.g., Seldane) - These medicines should not be taken with fluconazole, itraconazole, or ketoconazole; these azole antifungals may increase the chance of serious side effects of astemizole or terfenadine

• Atorvastatin (e.g., Lipitor) or
• Cerivastatin (e.g., Baycol) or
• Lovastatin (e.g., Mevacor) or
• Simvastatin (e.g., Zocor) - Use of these drugs with itraconazole or ketoconazole since increased levels of these drugs can cause serious muscular disorders.

• Busulfan (e.g., Myleran) or
• Docetaxel (e.g., Taxotere) or
• Vinblastine (e.g., Velban) or
• Vincristine (e.g., Oncovin) - Metabolism of these drugs may be delayed by itraconazole.

• Felodipine (e.g., Plendil) or
• Nifedipine (e.g., Procardia) or
• Verapamil (e.g., Isoptin, Covera) - Concurrent use can cause water retention or slow the heart rate.

• Carbamazepine (e.g., Tegretol) or
• Phenobarbital (e.g., Luminal)
• Phenytoin (e.g., Dilantin) - Concurrent use with itraconazole may decrease itraconazole concentrations. Phenytoin concentrations may be increased.

• Cisapride (e.g., Propulsid) - Cisapride should not be taken with itraconazole or oral ketoconazole; these azole antifungals may increase the chance of serious side effects of cisapride

• Cyclosporine (e.g., Sandimmune, Neoral)
• Tacrolimus (e.g., Prograf) - Concomitant use may cause increased concentrations of these drugs, resulting in toxicity.

• Didanosine (e.g., ddI, Videx) - Use of didanosine with itraconazole or ketoconazole may decrease the effects of itraconazole or ketoconazole, as well as of didanosine. Itraconazole and ketoconazole should be taken at least 2 hours before or 2 hours after didanosine is given

• Digoxin (e.g., Lanoxin) - Digoxin concentrations may be increased, resulting in toxicity.

• Dofetilide (eg., Tikosyn) or
• Pimozide (e.g.,Orap) or
• Quinidine (e.g., Quinaglute, Cardioquin, Quinidex) - Pimozide, dofetilide and quinidine should not be taken with itraconazole; itraconazole may increase the chance of serious side effects of pimozide, dofetilide and quinidine.

• Indinavir (e.g., Crixivan) or
• Ritonavir (e.g., Norvir) or
• Saquinivir (e.g., Invirase) - Use of these drugs with itraconazole or ketoconazole may increase the effects of indinavir

• Isoniazid or
• Rifampin (e.g., Rifadin) - These medicines may decrease the effects of azole antifungals

• Clarithromycin (e.g., Biaxin) or
• Erythromycin (e.g., E-Mycin) - Plasma concentrations of itraconazole may be increased.

• Nevirapine (e.g., Viramune) - Plasma concentrations of itraconazole or ketoconazole may be decreased.

• Warfarin (e.g., Coumadin) - Anticoagulant effects may be increased.

Other medical problems - The presence of other medical problems may affect the use of azole antifungals. Make sure you tell your doctor if you have any other medical problems, especially:

• Congestive heart failure - Itraconazole may slow down the heart rhythm and make heart failure worse.

• Achlorhydria (absence of stomach acid) or
• Hypochlorhydria (decreased amount of stomach acid) - Itraconazole and ketoconazole may not be absorbed from the stomach as well in patients who have low levels of or no stomach acid

• Alcohol abuse (or history of) or
• Liver disease - Alcohol abuse or liver disease may increase the chance of side effects caused by azole antifungals

• Kidney disease - The effects of fluconazole may be increased in patients with kidney disease