Ketoconazole increases the AUC and maximum levels of alfuzosin (as a modified- release preparation) by 3.2-fold and 2.3-fold, respectively. Itraconazole would be expected to interact similarly.
The manufacturers cautiously contraindicate ketoconazole and itraconazole. If the concurrent use of these azoles is essential it would seem prudent to use the minimum dose of the alpha blocker and titrate as necessary, monitoring for adverse effects, particularly first-dose hypotension. The risks are likely to be greater in patients also taking other antihypertensives. Other alpha blockers do not appear to interact, and therefore they may be suitable alternatives.
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