fluconazole and glibenclamide

MajorAvoid this combination where possible.

Mechanism

Fluconazole inhibits the CYP2C9-mediated metabolism of glibenclamide, increasing its plasma concentration and prolonging its hypoglycaemic effect.

What it means clinically

Enhanced and prolonged hypoglycaemia, including severe episodes with neuroglycopenic symptoms, may occur, particularly in patients with renal impairment or those on higher doses.

What to do

Monitor blood glucose closely, especially when starting or stopping fluconazole. Consider reducing the glibenclamide dose or switching to an alternative hypoglycaemic agent with a lower interaction potential.

Evidence

Well established in pharmacokinetic studies and case reports; the interaction is predictable and clinically relevant.

The two drugs

fluconazoletriazole antifungalRead the monograph glibenclamideSulfonylureaRead the monograph

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Other interactions involving fluconazole or glibenclamide

Educational reference for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.