CriticalAntifungal, triazole×First-generation antipsychotic, diphenylbutylpiperidine derivative
Updated · Methodology
Mechanism
Itraconazole is the strongest clinical CYP3A4 inhibitor. Pimozide concentration rises 10+ fold; torsades de pointes risk is maximal. FDA Orap Section 4 strict contraindication.
Symptoms
QT prolongation by day 3, syncope, torsades de pointes.
Management
Combination contraindicated. Alternative antifungal: terbinafine for superficial infections. For systemic infections, hold pimozide one week before itraconazole and resume 2 weeks after.
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Pimozide tablet (Par Health USA, LLC) – Prescribing Information (2011)– FDA Orap label, Section 4 Contraindications; DailyMed setid 70b079e2-a1f7-4a93-8685-d60a4d7c1280
- AEMPS: Ficha técnica: Itraconazol (nº registro 65775), sección 4.3 (2026)– AEMPS, CIMA, nº registro 65775, revisión 04/2026, sección 4.3