6 Fluconazole Interactions You Should Know About
Key takeaways:
Fluconazole (Diflucan) is a prescription medication that treats different types of fungal infections, including yeast infections.
Fluconazole has several interactions. For example, taking fluconazole with medications that affect your heart rhythm may raise your risk of developing arrhythmias.
Before starting fluconazole, talk to your prescriber or pharmacist to see if your medications or supplements may interact with it.
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Table of contents
Fluconazole (Diflucan) is a popular antifungal medication. It treats various infections caused by fungi, such as vaginal yeast infections, oral thrush, and more. Fluconazole is often prescribed as an oral tablet, but it also comes as a liquid suspension and IV injection.
Fluconazole is widely available and relatively affordable. But it can interact with other medications because of how it affects certain liver enzymes (proteins). These interactions can change how fluconazole or other medications work in your body. Some interactions may reduce medication effectiveness, while others could lead to added side effects.
Before starting your course of fluconazole, your prescriber and pharmacist will likely want to check for potential drug interactions. Make sure to give them a list of your current medications, including any over-the-counter (OTC) products, vitamins, or supplements you take.
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Fluconazole interaction summary
These medications are most known for interacting with fluconazole:
Amiodarone (Pacerone)
Anticoagulants, such as warfarin (Coumadin, Jantoven)
Antiplatelets, such as clopidogrel (Plavix)
Anti-seizure medications, such as phenytoin (Dilantin, Phenytek)
Calcium channel blockers, such as amlodipine (Norvasc, Norliqva)
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin)
Sulfonylureas, such as glyburide (DiaBeta, Glynase)
Statins, such as atorvastatin (Atorvaliq, Lipitor)
Lemborexant (Dayvigo)
Losartan (Cozaar)
Organ transplant medications, such as tacrolimus (Prograf)
Certain selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa)
Tricyclic antidepressants, such as amitriptyline
Benzodiazepines, such as alprazolam (Xanax)
Some opioids, such as methadone (Methadose)
Vinca alkaloids, such as vincristine
Some kinase inhibitors, such as tofacitinib (Xeljanz)
Other antifungals, such as voriconazole (Vfend)
Keep reading to learn more about six notable fluconazole interactions, which we discuss in detail below.
Keep in mind: This isn’t a complete list of medications that fluconazole can interact with. Make sure to check in with a healthcare professional when you start or stop a new medication or supplement while taking fluconazole.
1. Warfarin
Warfarin is a blood thinner that treats and prevents blood clots. It also helps prevent certain complications from occurring in people with heart conditions, such as strokes in those who have atrial fibrillation.
After you take warfarin, it gets broken down by two specific enzymes in the body. Fluconazole stops these enzymes from working efficiently. So, if you take warfarin and fluconazole at the same time, your INR can go up. This means your blood becomes too thin and takes longer to clot. This may cause you to bruise or bleed easily and can be dangerous if not managed appropriately.
If you take warfarin, you may still be able to take these medications together. But your healthcare professional may want to lower your warfarin dose while you’re taking fluconazole. They may also check your INR more often while taking both medications.
2. Amiodarone
Amiodarone is a medication that treats abnormal heart rhythms. Fluconazole can also affect your heart rhythm, albeit unintentionally. There’s a higher risk of developing abnormal heart rhythms when they’re taken together. Fluconazole can make amiodarone stick around your body longer, prolonging its effects.
Your healthcare professional may want to monitor your heart rhythm more often while taking both medications. Additionally, they may want to make sure that your body’s potassium and magnesium levels stay within normal levels. This can help prevent heart problems.
3. Clopidogrel
Clopidogrel is a common antiplatelet medication. It’s prescribed to certain people to lower the risk of heart attack and stroke by stopping blood clots.
Clopidogrel doesn’t start working right away, though. It only works after an enzyme in your body turns it on. Fluconazole can stop this enzyme from working, making clopidogrel ineffective. This worsens the risk of experiencing heart-related problems.
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If you take clopidogrel and receive a prescription for fluconazole, talk with your healthcare professional. They may prescribe a different antifungal to be safe.
4. Phenytoin
Phenytoin is a medication that helps prevent seizures in people living with epilepsy.
Normally, phenytoin gets removed from your body by a specific liver enzyme. Fluconazole can get in the way of this. This may lead to added phenytoin side effects because it’ll likely stay in your body for longer.
Brain-related side effects, such as drowsiness, slurred speech, or dizziness, are some potential consequences. Heart-related side effects, such as low blood pressure or heart rhythm changes, are also possible.
If you take phenytoin, your healthcare professional may want to check your levels more often while taking fluconazole. They may also lower your dose.
5. Statins, such as atorvastatin
Statins, such as atorvastatin and simvastatin (Zocor, FloLipid), are common medications for high cholesterol. They also offer benefits for many other health conditions, such as diabetes and heart disease. But they can have interactions with other medications, which is a frequent concern.
Fluconazole’s interactions with atorvastatin and simvastatin share a similar story to other medications on this list. Both statins are eliminated from the body by a specific enzyme, but fluconazole gets in the way. It can slow the way your body breaks them down. Higher statin levels can lead to added side effects. These can include muscle pain or rhabdomyolysis, in which the muscles break down and release harmful chemicals.
If you take atorvastatin or simvastatin and are prescribed fluconazole, your healthcare professional may consider doing a few things. They’ll likely check in with you more often to make sure you're not experiencing worse side effects. But they could also change your atorvastatin or simvastatin dose, temporarily pause your prescription, or switch you to a different medication that doesn't interact.
6. Citalopram
Citalopram is an antidepressant medication. It helps improve mood by raising the amount of serotonin in your brain.
Too much serotonin can be problematic, though. It can lead to serotonin syndrome, a potentially serious health condition. Citalopram doesn’t typically cause serotonin syndrome on its own, but the risk is higher while taking fluconazole. This is because fluconazole slows down two enzymes that typically break down citalopram.
Serotonin syndrome’s severity varies depending on the situation. Mild symptoms include sweating, shaky hands, and an elevated heart rate. But in rarer cases, more severe symptoms are possible. Emergent medical care is recommended for people experiencing the following symptoms of serotonin syndrome:
Confusion
An inability to open your mouth (lockjaw)
Difficulty getting up from lying or sitting position
Unable to control the movement of arms and legs
Rapid eye movements
Additionally, some antidepressants can affect your heart and raise the risk of abnormal rhythms. As with amiodarone, taking citalopram and fluconazole together can raise the risk of heart rhythm problems. This risk is further increased for people who have preexisting heart problems.
If you’re taking citalopram and fluconazole together, your healthcare professional may limit your citalopram dosage to 20 mg once daily.
Frequently asked questions
No, combining fluconazole with OTC yeast infection treatments isn’t recommended. Fluconazole works throughout your body, while most OTC treatments are applied topically. Using both simultaneously could increase the risk of side effects without making the overall treatment more effective. Always check with your healthcare professional before using any other medications, including OTC ones, while taking fluconazole.
There aren’t any specific foods to avoid while taking fluconazole. You can take it with or without food. However, fluconazole can cause nausea and stomach pain for some people, so taking it with food may help reduce these side effects. It’s also best to avoid alcohol while taking fluconazole. It may increase the risk of liver-related side effects.
The bottom line
Fluconazole (Diflucan) is an antifungal medication that has several possible interactions. Notable medications that can interact with fluconazole include warfarin (Coumadin, Jantoven), amiodarone (Pacerone), and clopidogrel (Plavix), among others. Some fluconazole interactions increase the risk of side effects of other medications, such as easy bleeding or heart rhythm problems. Others can affect how well other medications work in your body.
Before starting fluconazole, it’s recommended to talk to a healthcare professional about other medications you take, including any over-the-counter medications, herbal products, and supplements. They can check for potential interactions and advise if you need to make any changes to your medication regimen.
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References
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Eljaaly, K., et al. (2017). An updated review of interactions of statins with antibacterial and antifungal agents. Journal of Translational Science.
Govindarajan, A., et al. (2024). Fluconazole. StatPearls.
Gupta, M., et al. (2023). Phenytoin. StatPearls.
Leening, M. J. G. (2020). Who benefits from taking a statin, and when?: On fundamentally restructuring our thinking regarding primary prevention of cardiovascular disease. Circulation.
Meid, A. D., et al. (2017). Combinations of QTc-prolonging drugs: Towards disentangling pharmacokinetic and pharmacodynamic effects in their potentially additive nature. Therapeutic Advances in Psychopharmacology.
Mitchell, A. S., et al. (1989). Fluconazole and phenytoin: A predictable interaction. The BMJ.
Newman, C. B., et al. (2018). Statin safety and associated adverse events: A scientific statement from the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology.
Roerig. (2024). Diflucan- fluconazole tablet Diflucan- fluconazole powder, for suspension [package insert]. DailyMed.
Simon, L. V., et al. (2024). Serotonin syndrome. StatPearls.
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