Can I continue taking fluconazole (an antifungal medication) with Elequis (apixaban, an anticoagulant) and metoprolol (a beta blocker) together?

Fluconazole Can Be Taken With Eliquis (Apixaban) and Metoprolol, But Close Monitoring Is Recommended

You can continue taking fluconazole with Eliquis (apixaban) and metoprolol, but close monitoring for potential side effects is necessary due to possible drug interactions. 1, 2

Understanding the Drug Interactions

Fluconazole and Apixaban (Eliquis) Interaction

Fluconazole is a moderate inhibitor of CYP3A4 and CYP2C9 enzymes, which are involved in the metabolism of apixaban 1. This interaction may potentially:

• Increase apixaban plasma concentrations
• Increase risk of bleeding complications
• The interaction is not as severe as with stronger CYP inhibitors like ketoconazole 2

Fluconazole and Metoprolol Interaction

• Fluconazole does not significantly affect metoprolol metabolism
• Unlike some antidepressants that strongly inhibit CYP2D6 (the enzyme that metabolizes metoprolol), fluconazole primarily affects CYP2C9 and CYP3A4 1
• No specific contraindication exists for this combination 2

Monitoring Recommendations

1. Watch for bleeding signs while taking fluconazole with apixaban:

   • Unusual bruising
   • Nosebleeds
   • Blood in urine or stool
   • Excessive bleeding from minor cuts

2. Monitor for cardiovascular symptoms that could indicate metoprolol toxicity:

   • Excessive bradycardia (heart rate below 50 beats per minute)
   • Hypotension (systolic blood pressure below 100 mmHg)
   • Dizziness or lightheadedness
   • Unusual fatigue

3. Duration considerations:

   • Short-term fluconazole treatment (as prescribed for fungal pneumonia) poses less risk than long-term use 2
   • The standard treatment course for fungal pneumonia is typically 2-4 weeks 2

Risk Mitigation Strategies

1. Maintain your current fluconazole dose of 400 mg daily as prescribed for fungal pneumonia 2

2. Continue your regular doses of apixaban and metoprolol unless your cardiologist specifically advises otherwise 2

3. Complete the full course of antifungal treatment to effectively treat the fungal pneumonia 2

4. Contact your healthcare provider immediately if you experience:

   • Unusual bleeding or bruising
   • Severe dizziness or fainting
   • Irregular heartbeat
   • Severe shortness of breath

Important Considerations

• The risk of stopping your anticoagulant (Eliquis) likely outweighs the risk of the potential interaction with fluconazole 2

• Fungal pneumonia requires appropriate treatment, and fluconazole is an effective option 2

• The 400 mg dose of fluconazole is appropriate for systemic fungal infections like pneumonia 2

• Continue trying to reach your cardiologist for personalized advice, but the available evidence suggests that continuing all medications with monitoring is reasonable 2

Common Pitfalls to Avoid

1. Don't stop any medication without medical advice - abruptly discontinuing apixaban increases stroke risk, and stopping metoprolol can cause rebound hypertension

2. Don't adjust doses on your own - any dose adjustments should be made by your healthcare provider

3. Don't ignore new symptoms - report any unusual side effects promptly

4. Don't skip fluconazole doses - consistent antifungal therapy is essential for treating fungal pneumonia effectively 2

The benefit of treating your fungal pneumonia with fluconazole while maintaining your cardiovascular medications outweighs the potential risks of these drug interactions, especially with appropriate monitoring 2.