Is Clotrimazole Safe To Take Along With Fluconazole?

Posted on Mon, 4 Aug 2014

Question: My wife suffers from interstitial lung disease
she recently was released for the hospital
Her coughing and general condition of her lungs required this step
while hospitalized she suffered several attacks of atrial fibliration
She was sent home with oxygen and several medications which I
previously listed
My questions are:
1. Should she be taking both Clotrimazole and Fluconazole?
These were prescribed by two different doctors
Her Pulmonolist who prescribed Clotrimazole said she should not take Fluconazole
which was prescribed by an infectious specialist yesaterday
2. Should she be taking Prednisone with evidence of a fungus in her body?
3. How serious is the combination of interstitial lung diseasae and the a-fib?

Thank You

Answered by Dr. Arnab Maji (16 hours later)

Brief Answer:
Kindly go through the text below

Detailed Answer:
Hi,

Thanks for your query.

I am trying to give answers to each of your question below:
1. Both Clotrimazole and Fluconazole are anti-fungal drugs with more or less identical coverage. Therefore it's better to continue both at the same time and in this respect I think you should follow the advice of your pulmonologist who asked you not to take Fluconazole while taking clotrimazole.

2. Prednisone is the drug of choice for most of the interstitial lung diseases even sometimes in the face of infectious etiology. Though it is a immuno-suppressive therapy but usually at the dose of 0.5-1 mg/kg body weight, which I think is been prescribed by your pulmonologist, it will not enhance fungal infections or immuno-suppression.

3. Interstitial lung disease is itself a long standing disease without any favourable outcome. Though it cannot be told easily without knowing the exact diagnosis of interstitial lung disease. Moreover if it is combined with a-fib the outcome is worse. But all can be said conclusively only after knowing the definite category of interstitial lung disease.

If you have further queries you can ask me without hesitation.
Wishing your wife a quick recovery,

Thank you.
Regards,
Dr Arnab Maji
MBBS (Hons), MD
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Arnab Maji (12 hours later)

Thank You Doctor
I fully appreciate the seriousness of my wife's combined illnesses

I have a further question about your statement regarding the proper
or acceptable dosage for Prednisone

When you state that a dosage of "0.5-1mg/kg of body weight"---"it will
not enhance fungal infections or immuno-suppression"

Have I done the math correctly?
A woman weight 180# = 81kilos
A woman weighing 81 kilos can safely take a dosage
of up to 40mg based on .5mg/kilo
or up to 81mg based on 1mg/kilo?

Her pulmonogist had her on 50mg while hospitalized
and for 10 days following discharge
He has now reduced her dosage to 40mg/day

My wife has been on Prednisone fo at least 6 years with
dosages varying from 40 to 60mg per day. The heavier dosages
were ordered when ever she traveled--which was approx. 4-5 trips
per year from XXXXXXX to the West Coast--at least a five hour flight
each way--each trip--I was told that this was a factor

Her pulmonolist dianosed her with having "chronic bronchitis:
until April of this year. He has treated her for 8 years now

I am concerned about over dosingof Prednisone--if there is
such a thing? I have heard that extended usage of the medication
is not advisable and can be serious

I would appreciate your opinion

Thank You

Answered by Dr. Arnab Maji (17 hours later)

Brief Answer:
It will not cause any harm if properly tapered off

Detailed Answer:
Hello,
Thanks for writing back.

First of all chronic bronchitis is not categorized as an interstitial lung disease rather more appropriately it is an obstructive airway disease and obviously it may involve lung interstitium. No guideline in the world recommend prolonged antibiotic therapy for its treatment. Most of the guidelines recommend a course of steroid at a dose of 0.05-1 mg per kg body weight for 5-7 days or maximally 10-14 days. I think your wife must have some diagnosis rather than chronic bronchitis alone.

Your calculation is absolutely right. Your wife needs around 40-50 mg of prednisone daily to start with which your pulmonologist has started rightly and if it is a course of 5-7 days no tappering is needed. As your pulmonologist has given it for 10 days he started dose tappering rightly and gradually but not abruptly.

I don't know exactly what is the logic behind giving such frequent courses of steroid during your travelling. But I think those courses were for short duration only. In that case these would not cause any harm indeed. But prolonged therapy if tapered properly like the way your pulmonologist is doing now, will not cause any harm to your wife.

If you have any further queries, I am here to meet up those. Don't hesitate to ask me.

Thank you,
Regards
Dr Arnab Maji
MBBS (Hons), MD
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Vaishalee Punj