Clotrimazole drug interactions

Because trimetrexate is metabolized by a P450 enzyme system, drugs that induce or inhibit this drug metabolizing enzyme system may elicit important drug interactions that may alter trimetrexate plasma concentrations, which include erythromycin, rifampin, rifabutin, ketoconazole, fluconazole, cimetidine, nitrogen substituted imidazole drugs (eg, clotrimazole, ketoconazole, miconazole). 

Better compliance than with nystatin. Currently, the drug of choice for prophylaxis. A recent report suggested that clotrimazole troche can increase tacrolimus blood levels. (Vasquez E, Poliak R, Benedetti E. Clotrimazole increases tacrolimus blood levels a drug interaction in kidney transplant patients. Clin Transplant. 2001 15(2) 95-9.)... 

Topical therapy with clotrimazole or nystatin for 7 days is usually adequate for treating mucocutaneous candidiasis in most solid-organ transplant patients. Use of topical therapy will reduce the number of systemic drugs that these patients receive and hence minimize the risk of drug-drug interactions. Failure to respond to topical agents warrants the use of fluconazole. Low-dose amphotericin B 5-10 mg daily for 7 to 10 days is reserved for the unusual cases of treatment failure. 

Vasquez EM, Poliak R, Benedetti E. Clotrimazole increases tacrolimus blood levels a drug interaction in kidney transplant patients Clin Transplant (2001) 15,95-9... 

The interactions of tacrolimus with itraconazole and ketoconazole also appear to be established, and the manufacturer states that nearly all patients will require tacrolimus dose reductions when given these drugs. Information about clotrimazole is limited, but on the basis of the case report and study it would be prudent to monitor tacrolimus levels, and adjust the dose as necessary. 

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