Drug interactions
Fluconazole + Trabectedin
Severity: Major
Fluconazole and Trabectedin: 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 may increase trabectedin exposure, raising the risk of hepatotoxicity, myelosuppression and rhabdomyolysis.
What this interaction means in plain words
Fluconazole and Trabectedin 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; Trabectedin belongs to Oncology.
Why it happens
Fluconazole inhibits CYP3A4, the main enzyme metabolizing trabectedin.
What to do
Avoid the combination where possible, or monitor liver enzymes, CPK and blood counts closely. Consider an alternative antifungal with less CYP3A4 effect.
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
- Trabectedin 0.25 mg powder for concentrate for solution for infusion - SmPC sections 4.3/4.5 (names the partner; "d. Close monitoring of toxicities is required in patients receiving trabectedin in combination with potent CYP3A4 inhibitors (e.g. oral ketoconazole, fluconazol") — electronic medicines compendium (UK SmPC)
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 Trabectedin
Frequently asked questions
Can I take Fluconazole with Trabectedin?
MediHelp rates the interaction as major. Fluconazole and Trabectedin 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 increase trabectedin exposure, raising the risk of hepatotoxicity, myelosuppression and rhabdomyolysis.
How serious is the interaction between Fluconazole and Trabectedin?
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 the combination where possible, or monitor liver enzymes, CPK and blood counts closely. Consider an alternative antifungal with less CYP3A4 effect.
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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