Major
Fluconazole × Glibenclamide
Antifungals, triazole derivatives×Oral hypoglycemic agents. Sulfonylureas
Mechanism
Fluconazole at 200 mg/day or above blocks CYP2C9 – the main glibenclamide metabolic route. Glibenclamide plasma levels rise 2- to 3-fold; hypoglycaemic effect intensifies.
Symptoms
Severe hypoglycaemia: sweating, tremor, hunger, tachycardia, confusion; severe cases progress to seizures and coma. Symptoms appear within 1–7 days, especially in older patients and chronic kidney disease.
Management
For short fluconazole courses, monitor glucose 4 times daily; if needed, halve glibenclamide. Alternative antifungals: terbinafine for dermatophytosis or 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.