Moderate
Escitalopram × Fluconazole
Selective serotonin reuptake inhibitors (SSRIs)×Antifungals, triazole derivatives
Mechanism
Fluconazole weakly inhibits CYP3A4 and CYP2C19. Escitalopram levels may rise slightly. Additive QT risk is moderate — both prolong QT.
Symptoms
QT prolongation on ECG. Dizziness, syncope, palpitations. Rarely: polymorphic ventricular tachycardia (torsades de pointes). Risk is higher with hypokalaemia, hypomagnesaemia, bradycardia, and ischaemic heart disease.
Management
For short fluconazole courses (single 150 mg dose or 5–7 days) in patients without cardiac disease, no adjustment needed. For longer systemic therapy (over 14 days) in older patients, cap escitalopram at 10 mg/day and check ECG at 2 weeks. For superficial mycosis, alternative: topical clotrimazole or nystatin.