ANTIHISTAMINES AND AZOLES - ASTEMIZOLE, MIZOLASTINE OR TERFENADINE

Some of the azoles raise astemizole and terfenadine levels, which may increase the risk of serious life-threatening arrhythmias. Cases of torsade de pointes have been reported when astemizole is given with ketoconazole, and when terfenadine is given with itraconazole or ketoconazole. An arrhythmia has also been reported in a patient taking terfenadine and using topical oxiconazole. Ketoconazole raises mizolastine levels, which caused a small increase in the QT interval in one study.
The manufacturers of astemizole, mizolastine and terfenadine contraindicate the concurrent use of azoles and the manufacturer of terfenadine extends this contraindication to the concurrent use of topical azoles.
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