Drug interactions
fluconazole + prednisolone
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.
Overview
Fluconazole (a moderate CYP3A4 inhibitor) can increase prednisolone exposure, raising risk of corticosteroid adverse effects (e.g., Cushingoid features, hyperglycemia, hypertension, infection) and potential adrenal suppression.
Mechanism of action
Fluconazole inhibits CYP3A4-mediated metabolism of prednisolone, decreasing clearance and increasing systemic concentrations.
Clinical management
Avoid prolonged concomitant use when possible. If combined, use the lowest effective prednisolone dose and shortest duration; monitor for steroid toxicity (BP, glucose, weight/edema, mood changes, infection) and for adrenal suppression with longer courses; consider prednisolone dose reduction based on clinical response.
Drug reference
References
- Diflucan (fluconazole) Prescribing Information – Drug Interactions and CYP inhibition — FDA Label
- Prednisolone Prescribing Information – Drug Interactions with CYP3A4 inhibitors — FDA Label
- Fluconazole: Drug information (systemic azoles and CYP3A4 interactions with corticosteroids) — Lexicomp
- Azole antifungal drugs: Drug interactions (includes effects on systemic corticosteroids) — UpToDate
Frequently asked questions
Can I take fluconazole with prednisolone?
The interaction is rated: Moderate. Fluconazole (a moderate CYP3A4 inhibitor) can increase prednisolone exposure, raising risk of corticosteroid adverse effects (e.g., Cushingoid features, hyperglycemia, hypertension, infection) and potential adrenal suppression.
How serious is the interaction between fluconazole and prednisolone?
The interaction is rated: Moderate. Evidence level: Moderate.
How is the interaction between fluconazole and prednisolone managed?
Avoid prolonged concomitant use when possible. If combined, use the lowest effective prednisolone dose and shortest duration; monitor for steroid toxicity (BP, glucose, weight/edema, mood changes, infection) and for adrenal suppression with longer courses; consider prednisolone dose reduction based on clinical response.
Why do fluconazole and prednisolone interact?
Fluconazole inhibits CYP3A4-mediated metabolism of prednisolone, decreasing clearance and increasing systemic concentrations.
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