AZOLES AND PHENOBARBITAL - ITRACONAZOLE, POSACONAZOLE, OR VORICONAZOLE

Phenobarbital (given with carbamazepine or phenytoin) has been shown to decrease itraconazole levels resulting in treatment failure. Phenobarbital is predicted to decrease posaconazole and voriconazole levels. Note that primidone is metabolised to phenobarbital and therefore may interact similarly with these azoles.
Concurrent use should be avoided unless the benefits are expected to outweigh the risks, although note that the manufacturers contraindicate the use of voricona- zole. If concurrent use is necessary it seems likely that the antifungal dose will need to be increased. It would seem prudent to use other alternatives wherever possible or monitor concurrent use very closely.
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