التداخل بين ديكلوفيناك وفلوكونازول

Co-administration of diclofenac with CYP2C9 inhibitors (e.g. voriconazole) may enhance the exposure and toxicity of diclofenac whereas co- administration with CYP2C9 inducers (e.g. rifampin) may lead to compromised efficacy of diclofenac.

Intervention: A dosage adjustment may be warranted when diclofenac is administered with CYP2C9 inhibitors or inducers [ see Clinical Pharmacology ( 12.3 ) ] Drugs that Interfere with Hemostasis (e.g. warfarin, aspirin, SSRIs/SNRIs) : Monitor patients for bleeding who are concomitantly taking ZIPSOR with drugs that interfere with hemostasis.

CYP2C9 Inhibitors or Inducers: Clinical Impact Diclofenac is metabolized by cytochrome P450 enzymes, predominantly by CYP2C9.

Non-steroidal anti-inflammatory drugs The C max and AUC of flurbiprofen were increased by 23% and 81%, respectively, when coadministered with fluconazole compared to administration of flurbiprofen alone.

Although not specifically studied, fluconazole has the potential to increase the systemic exposure of other non-steroidal anti-inflammatory drugs (NSAIDs) that are metabolized by CYP2C9 (e.g., naproxen, lornoxicam, meloxicam, diclofenac).

Frequent monitoring for adverse events and toxicity related to NSAIDs is recommended.

Adjustment of dosage of NSAIDs may be needed.