Drug interactions
Fluconazole + Neratinib
Severity: Major
Fluconazole and Neratinib: major interaction.
Last updated Sources: EMA 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 may substantially increase neratinib exposure, worsening its adverse effects, particularly severe diarrhea and hepatotoxicity. Neratinib is heavily dependent on CYP3A4 for clearance.
What this interaction means in plain words
Fluconazole and Neratinib 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 belongs to Anti Fungals; Neratinib belongs to Oncology.
Why it happens
Fluconazole inhibits CYP3A4, reducing neratinib metabolism.
What to do
Avoid concomitant use; choose a non-CYP3A4-inhibiting antifungal. If used, monitor for diarrhea and liver enzyme elevation and manage with antidiarrheal prophylaxis.
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 Neratinib
- Amiodarone + Neratinib Major
- Amobarbital + Neratinib Major
- Aprepitant + Neratinib Major
- Armodafinil + Neratinib Major
- Bosentan + Neratinib Major
- Carbamazepine + Neratinib Major
Frequently asked questions
Can I take Fluconazole with Neratinib?
MediHelp rates the interaction as major. Fluconazole and Neratinib 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 may substantially increase neratinib exposure, worsening its adverse effects, particularly severe diarrhea and hepatotoxicity. Neratinib is heavily dependent on CYP3A4 for clearance.
How serious is the interaction between Fluconazole and Neratinib?
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 concomitant use; choose a non-CYP3A4-inhibiting antifungal. If used, monitor for diarrhea and liver enzyme elevation and manage with antidiarrheal prophylaxis.
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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