Pharmacology · patient case question
If this patient later develops oral candidiasis, which antifungal poses the greatest interaction risk with his statin?
Patient case: Polypharmacy — Cardiovascular & GI
demo: 68-year-old male
chief: “I need a crown on my lower left molar.”
history: Hypertension, gastroesophageal reflux disease, atrial fibrillation, hyperlipidemia, gout. Non-smoker.
meds: Lisinopril, omeprazole, verapamil, apixaban, rosuvastatin, allopurinol
findings: BP 132/84 mmHg. Generalized attrition. Tooth #19 with fractured MOD amalgam, no pulpal symptoms. No active periodontal disease.
Show answer and explanation
Correct answer: B. Fluconazole, because of the risk of rhabdomyolysis
- A. Topical amphotericin B is not associated with this interaction.
- B. Correct. Azoles such as fluconazole inhibit CYP-mediated statin metabolism. Raised statin levels can produce myopathy and, at the extreme, rhabdomyolysis — the classic pairing tested with simvastatin.
- C. Clotrimazole troches are largely topical, with far less systemic azole exposure than fluconazole.
- D. Nystatin is essentially not absorbed from the gut, so systemic interaction is negligible. It is the safer choice here.