Drug interactions
Itraconazole + Salmeterol
Severity: Major
Itraconazole and Salmeterol: major interaction.
Last updated Sources: US FDA label
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
Itraconazole strongly inhibits CYP3A4 and can markedly raise salmeterol exposure, increasing tachycardia, tremor, hypokalemia and QT prolongation. Itraconazole itself can prolong QT, adding to arrhythmic risk.
What this interaction means in plain words
Itraconazole and Salmeterol 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.
Itraconazole belongs to Anti Fungals; Salmeterol belongs to Respiratory.
Why it happens
Strong CYP3A4 inhibition reduces salmeterol clearance, combined with additive QT effects.
What to do
Avoid the combination where possible; use a non-CYP3A4-dependent bronchodilator or alternative antifungal. If unavoidable, monitor ECG, potassium and heart rate.
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 Salmeterol
- Ritonavir + Salmeterol Contraindicated
- Salmeterol + Saquinavir Contraindicated
- Amitriptyline + Salmeterol Major
- Arformoterol + Salmeterol Major
- Atazanavir + Salmeterol Major
- Budesonide-formoterol + Salmeterol Major
Other interactions of Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole Contraindicated
Frequently asked questions
Can I take Itraconazole with Salmeterol?
MediHelp rates the interaction as major. Itraconazole and Salmeterol 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. Itraconazole strongly inhibits CYP3A4 and can markedly raise salmeterol exposure, increasing tachycardia, tremor, hypokalemia and QT prolongation. Itraconazole itself can prolong QT, adding to arrhythmic risk.
How serious is the interaction between Itraconazole and Salmeterol?
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; use a non-CYP3A4-dependent bronchodilator or alternative antifungal. If unavoidable, monitor ECG, potassium and heart rate.
What other medicines interact with Salmeterol?
MediHelp also lists interactions of Salmeterol with, for example, Ritonavir, Saquinavir, Amitriptyline. The full list is on the Salmeterol page.
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