Nifedipine Fluconazole

Enalapril, paracetamol, sotalol, dipyrone, vancomycin, captopril, fluconazole, cefazolin, metoprolol, aspirin, ticlopidine, prednisolone, propranolol, digoxin, sildenafil, furosemide, dexamethasone, carvedilol, ketoprofen, nifedipine, terbinafine, acenocoumarol, spironolactone/urine HPLC DAD Column LiChroCART Purospher STAR, RP-18e (250 x 4 mm, 5 pm) Mobile phase MeOH ACN 0.05 % TFA in water (gradient elution) Detection DAD X = 200 50 nm Adjusted to pH 7.0, protein precipitation LOD 0.01-1.44 pg/mL LOQ 0.04-4.35 pg/mL [72]... 

Fluconazole enhanced the blood pressure-lowering effects of nifedipine by increasing its plasma concentrations in a 16-year-old patient with malignant pheochromocytoma taking chronic nifedipine for arterial hjrpertension who was given fluconazole for Candida septicemia (81). 

Kremens B, Brendel E, Bald M, Czyborra P, Michel MC. Loss of blood pressure control on withdrawal of fluconazole during nifedipine therapy. Br J Clin Pharmacol 1999 47(6) 707-8. 

A pharmacokinetic interaction between fluconazole and nifedipine has been reported (54). 

A 16-year-old man with neurofibromatosis type 1, a malignant pheochromocytoma with lung and bone metastases, and candidiasis of the gastrointestinal tract with fungemia was taking nifedipine for arterial hjrper-tension. The fungal infection responded to fluconazole, but three attempts to withdraw the fluconazole resulted in recurrence of headache, palpitation, and increased blood pressure. 

CYP3A4 Alfentanil Alprazolam Astern izole Carbamazepine Cisapride Cyclosporine Diltiazem Erythromycin Felodipine Fluconazole Itraconazole Ketoconazole Lidocaine Lova statin Midazolam Nifedipine Quinidine Simvastatin Tacrolimus Terfenadine Verapamil... 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, amlodi-pine, carbamazepine, cefotaxime, ceftazidime, chloramphenicol, ciprofloxacin, cisapride, clindamycin, clonidine, codeine, cyclosporine, digoxin, diphenhydramine, disopyramide, ethosuximide, fluconazole, gentamicin, gentamicin, heparin, labetalol, levothyroxine, li-docaine, lithium, methotrexate, metronidazole, minoxidil, nafcillin, nifedipine, phenobar-bital, phenobarbital, phenytoin, phenytoin, primidone, procainamide, propranolol, quini-dine, ranitidine, salicylic acid, theophylline, tobramycin, tobramycin, valproic acid, warfarin... 

Itraconazole can markedly raise the serum levels of felodipine, which Increases Its adverse effects, In particular ankle and leg oedema. A few case reports suggest that isradipine and nifedipine can interact similarly with itraconazole, and that fluconazole can also interact with nifedipine. Ketoconazole can markedly raise the plasma levels of lercanidipine and nisoldipine. Caution is warranted with all calcium-channel blockers when azole antifungals, particularly itraconazole and ketoconazole, are used. 

The interaction between felodipine and itraconazole would appear to be established and elinieally important. It also seems that isradipine, lercanidipine, nifedipine and nisoldipine ean interaet similarly with fluconazole, itraconazole or ketoconazole and, because they are metabolised by CYP3A4, it is likely that other calcium-channel blockers will behave in the same way. If itraconazole, ketoconazole, or fluconazole is given to a patient on established treatment with any calcium-channel blocker be alert for the need to lower the dosage of the calcium-channel blocker. However, some manufaeturers (e.g. felodipine, lercanidipine ) actually contraindicate concurrent use of itraconazole or ketoconazole, and others (e.g. nisoldipine ) additionally contraindicate fluconazole. In the US the guidance differs slightly and only caution is considered necessary with felodipine. The manufacturers of nimodipine predict that fluconazole, itraconazole and ketoconazole will substantially raise nimodipine levels. They say that concurrent use should be avoided, but, if this is not possible then the patient s blood pressure should be carefully monitored."... 

Class 1 (High Permeability, High Solubihty) Albuterol, Allopurinol, Amlodipine (Amlo), AmoxicilUn, Antipyiine, Dexamethasone, Diltiazem, Zidovudine, Isosoibide mononitrate, Ketoprofen, Lamivudine, Levonoigestiel, Levofloxa-cin. Metronidazole, Midazolam, Minocycline, Morphine, Nifedipine, Ofloxacin, Prednisolone, Propylthiouracil, Stavudine, Phenobaibital, Fluconazole, Chiiiin, Enalapril, Acetaminophen, Diazepam, Lsoniazid, Levodopa, Metoprolol, Paracetamol, Pyrazinamide, Salicylic add, Ethirtylestradiol. ... 

Both nifedipine and eplerenone are metabolized by CYP3A4, which is inhibited by voriconazole. Other azoles, such as fluconazole, reportedly also interact with nifedipine, but such an interaction has not been demonstrated with eplerenone. 

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