Drug interactions
Bedaquiline + Voriconazole
Severity: Major
Bedaquiline and Voriconazole: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Voriconazole increases bedaquiline exposure through CYP3A4 inhibition. Because bedaquiline prolongs the QT interval and voriconazole does as well, the risk of QT-related arrhythmia and hepatotoxicity is increased.
What this interaction means in plain words
Bedaquiline and Voriconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Bedaquiline belongs to Anti Bacterial; Voriconazole belongs to Anti Fungals.
Why it happens
CYP3A4 inhibition reduces bedaquiline clearance, with additive QTc prolongation.
What to do
Avoid use beyond 14 days unless benefit outweighs risk. If co-administered, obtain baseline and serial ECGs, correct potassium, magnesium and calcium, and monitor liver enzymes.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Voriconazole
- Avanafil + Voriconazole Contraindicated
- Butabarbital + Voriconazole Contraindicated
- Carbamazepine + Voriconazole Contraindicated
- Conivaptan + Voriconazole Contraindicated
- Dihydroergotamine intranasal + Voriconazole Contraindicated
- Dihydroergotamine + Voriconazole Contraindicated
Other interactions of Bedaquiline
- Bedaquiline + Ziprasidone Contraindicated
- Alfuzosin + Bedaquiline Major
- Amiodarone + Bedaquiline Major
- Amisulpride + Bedaquiline Major
- Amitriptyline + Bedaquiline Major
- Amobarbital + Bedaquiline Major
Frequently asked questions
Can I take Bedaquiline with Voriconazole?
MediHelp rates the interaction as major. Bedaquiline and Voriconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Voriconazole increases bedaquiline exposure through CYP3A4 inhibition. Because bedaquiline prolongs the QT interval and voriconazole does as well, the risk of QT-related arrhythmia and hepatotoxicity is increased.
How serious is the interaction between Bedaquiline and Voriconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid use beyond 14 days unless benefit outweighs risk. If co-administered, obtain baseline and serial ECGs, correct potassium, magnesium and calcium, and monitor liver enzymes.
What other medicines interact with Voriconazole?
MediHelp also lists interactions of Voriconazole with, for example, Avanafil, Butabarbital, Carbamazepine. The full list is on the Voriconazole page.
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