May 9, 1994, Vol 154, No. 9 >

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ARTICLE | May 9, 1994

Ketoconazole and Fluconazole Drug Interactions

Peter K. Honig, MD; Louis R. Cantilena, MD, PhD

Arch Intern Med. 1994;154(9):1038-1041. doi:10.1001/archinte.1994.00420090130018.

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We read with interest the article on ketoconazole and fluconazole drug interactions by Baciewicz and Baciewicz,¹ which appeared in the Archives. We agree that the azole antifungals have the capability to influence the metabolism of a wide variety of concurrently administered drugs and the Food and Drug Administration is increasingly aware of such potential interactions.²

The authors fail to cite recent information regarding interactions between the popular nonsedating antihistamines and these antifungal agents. A prospective study³ conducted by our group has shown ketoconazole to influence the biotransformation of terfenadine, allowing the accumulation of the cardiotoxic parent compound. The concomitant administration of these drugs is contraindicated. A similar interaction study of terfenadine and fluconazole did not demonstrate any clinically significant cardiac repolarization abnormalities.⁴

We also feel that it is important to mention that concomitant administration of ketoconazole and astemizole is contraindicated (as indicated on Hismanal [Janssen Pharmaceutica,

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Honig PK, Cantilena LR. Ketoconazole and Fluconazole Drug Interactions. Arch Intern Med. 1994;154(9):1038-1041. doi:10.1001/archinte.1994.00420090130018.

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