Drug interactions
Siponimod + Voriconazole
Severity: Major
Siponimod and Voriconazole: major interaction.
Last updated
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
Siponimod is cleared mainly by CYP2C9 with a smaller contribution from CYP3A4. Voriconazole inhibits both enzymes, so siponimod exposure can rise substantially, increasing the risk of bradyarrhythmia, lymphopenia and other dose-related adverse effects.
What this interaction means in plain words
Siponimod and Voriconazole 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.
Siponimod belongs to Central Nervous System; Voriconazole belongs to Anti Fungals.
Why it happens
Voriconazole inhibits CYP2C9 and CYP3A4, reducing the combined metabolic clearance of siponimod.
What to do
Avoid the combination in line with siponimod labeling and choose a non-azole antifungal if feasible. If it cannot be avoided, monitor heart rate, ECG and lymphocyte counts closely.
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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Other interactions of Voriconazole
- Avanafil + Voriconazole Contraindicated
- Butabarbital + Voriconazole Contraindicated
- Carbamazepine + Voriconazole Contraindicated
- Conivaptan + Voriconazole Contraindicated
- Dihydroergotamine intranasal + Voriconazole Contraindicated
- Dihydroergotamine + Voriconazole Contraindicated
Other interactions of Siponimod
- Cladribine + Siponimod Contraindicated
- Fingolimod + Siponimod Contraindicated
- Fluconazole + Siponimod Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Siponimod Contraindicated
- Ponesimod + Siponimod Contraindicated
- Siponimod + Thioridazine Contraindicated
Frequently asked questions
Can I take Siponimod with Voriconazole?
MediHelp rates the interaction as major. Siponimod and Voriconazole 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. Siponimod is cleared mainly by CYP2C9 with a smaller contribution from CYP3A4. Voriconazole inhibits both enzymes, so siponimod exposure can rise substantially, increasing the risk of bradyarrhythmia, lymphopenia and other dose-related adverse effects.
How serious is the interaction between Siponimod and Voriconazole?
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 in line with siponimod labeling and choose a non-azole antifungal if feasible. If it cannot be avoided, monitor heart rate, ECG and lymphocyte counts closely.
What other medicines interact with Voriconazole?
MediHelp also lists interactions of Voriconazole with, for example, Avanafil, Butabarbital, Carbamazepine. The full list is on the Voriconazole page.
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