From the Research
It is not recommended to give fluconazole 150 mg once weekly for four weeks to a patient taking clopidogrel due to a significant drug interaction. This interaction is due to fluconazole's inhibition of the CYP2C19 enzyme, which is responsible for converting clopidogrel into its active metabolite, thereby reducing clopidogrel's antiplatelet effectiveness and potentially increasing the risk of thrombotic events such as heart attack or stroke in patients who need this medication for cardiovascular protection 1, 2. The provided evidence does not directly address the interaction between fluconazole and clopidogrel, but it highlights the importance of considering drug interactions when prescribing medications such as voriconazole 3, 4 and itraconazole 5. Given the potential risks, alternative options should be considered for antifungal treatment, such as:
- Topical antifungals for localized fungal infections that do not interact with clopidogrel
- Consultation with cardiology and infectious disease specialists to determine the safest approach, which might include temporary adjustment of antiplatelet therapy or selection of an alternative antifungal with less interaction potential. In clinical practice, the decision to prescribe fluconazole to a patient taking clopidogrel should be made with caution, taking into account the potential risks and benefits, and considering alternative treatment options to minimize the risk of adverse interactions.