Major
Clopidogrel × Fluconazole
Antiplatelet agents – P2Y12 receptor inhibitors×Antifungals, triazole derivatives
Mechanism
Fluconazole inhibits CYP2C19, the key enzyme converting clopidogrel into its active metabolite. Active levels fall by 25–50% and the antiplatelet effect weakens.
Symptoms
The patient feels no symptoms – the weakened antiplatelet effect is silent. Risk of recurrent coronary events and stent thrombosis rises.
Management
For a short fluconazole course, the effect is clinically minor. For prolonged systemic therapy (>14 days), an alternative antiplatelet is ticagrelor (not CYP2C19-dependent). Alternative antifungal: echinocandins for systemic mycoses.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.