Diflucan (Fluconazole Oral Suspension) and Xarelto Starter Pack

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

If you have kidney disease, you should talk to your doctor before using rivaroxaban together with fluconazole. Combining these medications can significantly increase the blood levels of rivaroxaban and increase the risk of serious or life-threatening bleeding complications. If treatment with the combination is required, you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Call your doctor promptly if you experience any unusual bleeding or bruising, swelling, vomiting, blood in your urine or stools, headache, dizziness, or weakness during treatment with these medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Coadministration with moderate or potent inhibitors of CYP450 3A4 may increase the plasma concentrations of rivaroxaban, which is a substrate of the isoenzyme. This interaction is not expected to be clinically significant in patients with normal renal function, but may be important in patients with renal impairment. When a single dose of rivaroxaban was coadministered with the moderate CYP450 3A4 inhibitor, fluconazole, rivaroxaban peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 30% and 40%, respectively. These increases are within the magnitude of the normal variability of Cmax and AUC and are not considered clinically relevant. However, the magnitude of interaction may be greater in patients with renal impairment. Even in the absence of concomitant CYP450 3A4 inhibitors, rivaroxaban AUC was increased 1.4-, 1.5- and 1.6 fold in individuals with mild (CrCl 50 to 80 mL/min), moderate (CrCl 30 to 49 mL/min) and severe (CrCl 15 to 29 mL/min) renal impairment, respectively, compared to healthy subjects with normal renal function (CrCl 80 mL/min or greater). Overall inhibition of factor Xa activity increased by a factor of 1.5, 1.9 and 2.0, and prolongation of PT was similarly increased by a factor of 1.3, 2.2 and 2.4, respectively. There are no data in patients with CrCl below 15 mL/min.

MANAGEMENT: In patients with significant renal impairment (e.g., CrCl between 15 to 50 mL/min), the use of rivaroxaban with moderate or potent inhibitors of CYP450 3A4 should be approached with caution. Patients should be routinely evaluated for signs and symptoms suggesting blood loss such as a drop in hemoglobin and/or hematocrit, hypotension, or fetal distress (in pregnant women). Renal function should also be assessed periodically, and treatment with rivaroxaban discontinued if acute renal failure develops. Due to the lack of clinical data, rivaroxaban is not recommended in patients with CrCl below 30 mL/min when used for the prophylaxis of deep vein thrombosis and in patients with CrCl below 15 mL/min when used for reducing the risk of stroke and systemic embolism in nonvalvular atrial fibrillation.

Diflucan (Fluconazole Oral Suspension)

Generic Name: fluconazole

Brand name: Diflucan

Synonyms: Diflucan

What is Diflucan (Fluconazole Oral Suspension)?

Xarelto Starter Pack

Generic Name: rivaroxaban

Brand name: Xarelto, Xarelto Starter Pack

Synonyms: Xarelto

What is Xarelto Starter Pack?