Amphotericin B (Ordinary and Liposomal Forms)

• fever
• chills
• nausea
• kidney toxicity

Drugs such as miconazole and ketoconazole, when given at the same time, may worsen damage to the kidneys and decrease the effectiveness of amphotericin B. As well, carbenicillin, digitalis and ticarcillin may interact with amphotericin B and cause the kidneys to malfunction.

Fluconazole

In general, fluconazole is usually "well tolerated" by patients. None the less, some patients may experience:

• nausea and/or vomiting
• headache
• rash
• stomach pain and diarrhea can also be a problem

Fluconazole may interact with several other drugs:

• Rifampin.

• This anti-TB drug may decrease the level of fluconazole in the blood. Some doctors suggest increased doses of fluconazole when patients are using rifampin

• Phenytoin.

• Blood levels of this drug increase when given to patients taking fluconazole

Ketoconazole

• nausea
• vomiting

When this antifungal is taken with food its absorption is decreased. Some doctors increase the dose given to patients with HIV infection because of low levels of stomach acid. Thus patients using the anti-ulcer drugs cimetidine (Tagamet(R)) or ranitidine (Zantac(R)) should not take ketoconazole at the same time as those other drugs.

Rifampin

This antibiotic can significantly reduce blood levels of ketoconazole

Hismanal(R)(astemizole) and Seldane(R)(terfenadine).

These anti-allergy drugs interact with ketoconazole resulting in high blood levels of Hismanal or Seldane. This interaction can lead to heart problems and even death.

Itraconazole

This antifungal appears to be "well-tolerated". Side effects include:

• nausea
• rash
• vomiting
• liver toxicity (particularly in patients who have hepatitis)

Itraconazole can interact with several drugs and this interaction can kill patients:

Hismanal (astemizole) and Seldane (terfenadine) can interact with itraconazole and cause heart problems leading to death.

The following drugs can reduce blood levels of itraconazole-- cimetidine (and related compounds), isoniazid, phenytoin and rifampin.

Flucytosine

• bone marrow toxicity
• nausea and/or vomiting

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Copyright © 1993 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca