Drug interactions
Escitalopram + Fluconazole
Severity: Major
Escitalopram and Fluconazole: major interaction.
Last updated Sources: UK SmPC
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
Fluconazole inhibits CYP2C19 and CYP3A4, which metabolize escitalopram, so levels may rise. Both drugs prolong the QT interval, raising the risk of torsades de pointes.
What this interaction means in plain words
Escitalopram and Fluconazole 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.
Escitalopram belongs to Central Nervous System; Fluconazole belongs to Anti Fungals.
Why it happens
CYP2C19/CYP3A4 inhibition raises escitalopram exposure, with additive QT prolongation.
What to do
Obtain baseline ECG and correct hypokalemia and hypomagnesemia. Use a lower escitalopram dose (maximum around 10 mg daily when combined with CYP2C19 inhibitors) and monitor ECG.
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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References
Other interactions of Fluconazole
- Dihydroergotamine intranasal + Fluconazole Contraindicated
- Dihydroergotamine + Fluconazole Contraindicated
- Dofetilide + Fluconazole Contraindicated
- Domperidone + Fluconazole Contraindicated
- Dronedarone + Fluconazole Contraindicated
- Erythromycin + Fluconazole Contraindicated
Other interactions of Escitalopram
- Cisapride + Escitalopram Contraindicated
- Citalopram + Escitalopram Contraindicated
- Escitalopram + Isocarboxazid Contraindicated
- Escitalopram + Methylene blue Contraindicated
- Escitalopram + Phenelzine Contraindicated
- Escitalopram + Pimozide Contraindicated
Frequently asked questions
Can I take Escitalopram with Fluconazole?
MediHelp rates the interaction as major. Escitalopram and Fluconazole 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. Fluconazole inhibits CYP2C19 and CYP3A4, which metabolize escitalopram, so levels may rise. Both drugs prolong the QT interval, raising the risk of torsades de pointes.
How serious is the interaction between Escitalopram and Fluconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Obtain baseline ECG and correct hypokalemia and hypomagnesemia. Use a lower escitalopram dose (maximum around 10 mg daily when combined with CYP2C19 inhibitors) and monitor ECG.
What other medicines interact with Fluconazole?
MediHelp also lists interactions of Fluconazole with, for example, Dihydroergotamine intranasal, Dihydroergotamine, Dofetilide. The full list is on the Fluconazole page.
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