To : Jan
Re : Cisapride and Azole antifungals

It is true that cisapride metabolism can be significantly inhibited with the
use of most of the azole antifungals, particularly, itraconazole,
ketoconazole, miconazole, and clotrimazole... and maybe fluconazole, when
the antifungal is used orally in significant doses...  Cisapride levels rise
to dangerous levels and myocardial arrhythmias can occur.

Now, whether this would occur with the small amount on a nipple, is
questionable.  I would certainly be cautious and minimize the amount on the
nipple.  In fact, I would probably discontinue these azole antifungals, and
switch to nystatin  or gentian violet instead.

Regards

Tom Hale, Ph.D.