Which drugs are contraindicated when using azole antifungal agents and why?

Contraindicated drugs are cisapride (pulled off the U.S. market in 2000), astemizole (pulled off the U.S. market in 1999), terfenadine (pulled off the U.S. market in 1998), lovastatin, midazolam, and triazolam. When combined with azole antifungal agents, these drugs can cause severe or life-threatening reactions. Elevated levels of cisapride, astemizole, and terfenadine are associated with cardiac arrhythmias, especially torsades de pointes. The metabolism of lovastatin is markedly reduced and can result in rhabdomyolysis. Simvastatin, atorvastatin, and cerivastatin are metabolized by the same hepatic cytochrome and also should be avoided.