Nateglinide Itraconazole

Niemi M, Backman JT, Juntti-Patinen L, Neuvonen M, Neuvonen PJ. Coadministration of gemfibrozil and itraconazole has only a minor effect on the pharmacokinetics of the CYP2C9 and CYP3A4 substrate nateglinide. Br J Clin Pharmacol 2005 60 208 117. 

Itraconazole also appears not to affect diabetic control in most patients, but there are reports of hypoglycaemia or hyperglycaemia associated with its use. Itraconazole causes modest increases in repaglinide and nateglinide levels, but has no effect on pioglita-zone pharmacokinetics. Ketoconazole increases the blood glu-... 

The modest changes in repaglinide pharmacokinetics with ketoconazole and itraconazole may be because repaglinide is metabolised by both CYP2C8 and CYP3A4, and one pathway may have the capacity to compensate if the other is inhibited. Similarly, itraconazole modestly affects nateglinide metabolism via CYP3A4. ... 

In contrast, in a very similar study by the same research group, the combination of gemfibrozil and itraconazole caused only a modest 47% increase in the AUC of a single dose of nateglinide 30 mg, and did not significantly alter the blood glucose response to nateglinide in healthy subjects. ... 

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