Antifungals

The azoles — ketoconazole, itraconazole, miconazole, fluconazole. They work by blocking a fungal cytochrome P450 that builds the fungal membrane, and the reason they sit in a drug reference is that they do not stop at the fungal enzyme. They inhibit human CYP3A4 as well, so anything cleared by that route accumulates while an azole is on board, and much of this tree is cleared by that route — the benzodiazepines and the synthetic opioids among them.

How much depends on the member. Itraconazole and ketoconazole are strong inhibitors, fluconazole is weaker and leans on different enzymes, and route is no guarantee either: an oral gel is not automatically outside the interaction. The harm here is rarely the antifungal. It is that a dose of something else, unchanged from last week's, is not the same exposure this week.