Major
Established
Deskripsi
Fluconazole inhibits the metabolism of ondansetron and both drugs prolong the QT interval, creating a compounded arrhythmia risk.
Mekanisme
Fluconazole inhibits CYP3A4 and CYP2C9, reducing ondansetron clearance and increasing its plasma concentrations; both drugs independently block hERG channels.
Signifikansi Klinis
The combination can markedly increase ondansetron exposure and QTc prolongation; cases of torsades de pointes have been documented.
Penatalaksanaan
Avoid combination or use the lowest effective ondansetron dose with ECG monitoring; correct hypokalemia before initiating.