AZOLES AND ERGOT DERIVATIVES
Ketoconazole, itraconazole, posaconazole and voriconazole may increase the levels of ergot derivatives such as ergotamine, dihydroergotamine, and methysergide, which may result in ergotism. Other azoles, such as fluconazole, may interact similarly, although to a lesser extent.
The UK manufacturers of various ergot derivatives contraindicate use with all azole antifungals. The US manufacturers of ergotamine and dihydroergotamine advise caution with fluconazole and clotrimazole, which are moderate CYP3A4 inhibitors. Any patient taking an ergot derivative with an azole should be closely monitored for signs of ergotism.
The UK manufacturers of various ergot derivatives contraindicate use with all azole antifungals. The US manufacturers of ergotamine and dihydroergotamine advise caution with fluconazole and clotrimazole, which are moderate CYP3A4 inhibitors. Any patient taking an ergot derivative with an azole should be closely monitored for signs of ergotism.