From the Research
Fluconazole (Diflucan) can significantly reduce the effectiveness of clopidogrel (Plavix), potentially increasing the risk of cardiovascular events in patients taking both medications, as evidenced by a recent case report in 2022 1. This interaction occurs because fluconazole inhibits the CYP2C19 enzyme in the liver, which is necessary to convert clopidogrel into its active form. Without this conversion, clopidogrel cannot effectively prevent platelet aggregation and blood clot formation. If you are taking clopidogrel for prevention of heart attack or stroke, this interaction could leave you inadequately protected. Some key points to consider about this interaction include:
- The mechanism of the interaction is related to the inhibition of the CYP2C19 enzyme by fluconazole, which is supported by the most recent study in 2022 1.
- The risk of cardiovascular events may be increased when these medications are used together, as suggested by the case report in 2022 1.
- Alternative antifungal medications that don't affect CYP2C19 should be considered when possible.
- If both medications must be used together, your healthcare provider might consider increasing clopidogrel dosing, switching to a different antiplatelet medication like ticagrelor or prasugrel (which are less affected by this interaction), or monitoring you more closely for signs of reduced clopidogrel effectiveness, as there is no single best approach supported by the available evidence 1. Never adjust these medications on your own - always consult with your healthcare provider about this potentially serious drug interaction.