Ketoconazole interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Excessive use of alcohol or products containing alcohol together with ketoconazole or levoketoconazole may potentiate the risk of liver injury. Serious hepatotoxicity has been reported with levoketoconazole. Fatal hepatotoxicity or requiring liver transplantation have been reported with the use of oral ketoconazole, of which levoketoconazole is an enantiomer.

  What to do: Excessive consumption of alcohol should generally be avoided during ketoconazole or levoketoconazole therapy. Patients receiving ketoconazole or levoketoconazole should be instructed to contact their doctor immediately if they experience swelling, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark colored urine, light colored stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage.

  3 sources

  1. "Product Information. Nizoral (ketoconazole)." Janssen Pharmaceuticals (2002):
  2. "Product Information. Ketoconazole (ketoconazole)." Mylan Pharmaceuticals Inc (2019):
  3. "Product Information. Recorlev (levoketoconazole)." Xeris Pharmaceuticals Inc (2022):

Conditions

Conditions in which Ketoconazole needs care, as documented in this source.

• Liver Diseases

  Major

  Serious hepatotoxicity including cases with a fatal outcome or requiring liver transplant have been reported. Some patients had no obvious risk factors for liver disease. Liver function tests should be performed prior to initiation of therapy and regularly during treatment in patients receiving prolonged therapy with ketoconazole, particularly those with a current or past history of liver disease. Therapy should be withdrawn if persistent elevations or worsening of liver enzyme levels occur, or if the abnormalities are accompanied by symptoms of possible liver injury. Since ketoconazole is primarily metabolized by the liver, empirically reducing the dosage may also be appropriate in patients with existing liver disease. The use of oral ketoconazole tablets is contraindicated in patients with acute or chronic liver disease.

  11 sources

  1. Knight TE, Shikuma CY, Knight J "Ketoconazole-induced fulminant hepatitis necessitating liver transplantation." J Am Acad Dermatol 25 (1991): 398-400
  2. Duarte PA, Chow CC, Simmons F, Ruskin J "Fatal hepatitis associated with ketoconazole therapy." Arch Intern Med 144 (1984): 1069-70
  3. Lewis JH, Zimmerman HJ, Benson GD, Ishak KG "Hepatic injury associated with ketoconazole therapy: analysis of 33 cases." Gastroenterology 86 (1984): 503-13
  4. Bercoff E, Bernuau J, Degott C, et al. "Ketoconazole-induced fulminant hepatitis." Gut 26 (1985): 636-8
  5. Stricker BH, Blok AP, Bronkhorst FB, et al. "Ketoconazole-associated hepatic injury: a clinicopathological study of 55 cases." J Hepatol 3 (1986): 399-406
  6. Lake-Bakaar G, Scheuer PJ, Sherlock S "Hepatic reactions associated with ketoconazole in the United Kingdom." Br Med J (Clin Res Ed) 294 (1987): 419-22
  7. van Parys G, Evenepoel C, van Damme B, Desmet VJ "Ketoconazole-induced hepatitis: a case with a definite cause-effect relationship." Liver 7 (1987): 27-30
  8. McCance DR, Ritchie CM, Sheridan B, Atkinson AB "Acute hypoadrenalism and hepatotoxicity after treatment with ketoconazole." Lancet Mar (1987): 573

  Show all 11 sourcesShow fewer sources

  9. Gradon JD, Sepkowitz DV "Massive hepatic enlargement with fatty change associated with ketoconazole." Ann Pharmacother 24 (1990): 1175-6
  10. "Product Information. Nizoral (ketoconazole)." Janssen Pharmaceuticals (2002):
  11. Chien RN, Yang LJ, Lin PY, Liaw YF "Hepatic injury during ketoconazole therapy in patients with onychomycosis: a controlled cohort study." Hepatology 25 (1997): 103-7

• Achlorhydria

  Moderate

  Nizoral (brand of ketoconazole) tablets require acidity for proper dissolution and absorption. Therefore, the drug may not be effective in patients with achlorhydria. Taking the medication with an acidic beverage such as orange or cranberry juice may help, but an alternative antifungal agent should be considered.

  5 sources

  1. Lake-Bakaar G, Tom W, Lake-Bakaar D, et al. "Gastropathy and ketoconazole malabsorption in the acquired immunodeficiency syndrome (AIDS)." Ann Intern Med 109 (1988): 471-3
  2. Mannisto PT, Mantyla R, Nykanen S, et al. "Impairing effect of food on ketoconazole absorption." Antimicrob Agents Chemother 21 (1982): 730-3
  3. Daneshmend TK, Warnock DW, Ene MD, et al. "Influence of food on the pharmacokinetics of ketoconazole." Antimicrob Agents Chemother 25 (1984): 1-3
  4. Daneshmend TK "Diseases and drugs but not food decrease ketoconazole "bioavailability"." Br J Clin Pharmacol 29 (1990): 783-4
  5. "Product Information. Nizoral (ketoconazole)." Janssen Pharmaceuticals (2002):

• Adrenal Insufficiency

  Moderate

  Ketoconazole tablets decrease adrenal corticosteroid secretion at doses of 400 mg and higher. Adrenal function should be monitored in patients with adrenal insufficiency or with borderline adrenal function and in patients with prolonged periods of stress due to major surgery, intensive care, etc.

  1 source

  1. "Product Information. Nizoral (ketoconazole)." Janssen Pharmaceuticals (2001):

• Long QT Syndrome

  Moderate

  Some azole antifungals have been associated with prolongation of the QT interval on the ECG. Rare cases of QT prolongation and torsade de pointes have been reported during postmarketing experience; such reports usually involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications. These drugs should be administered with caution to patients with potentially proarrhythmic conditions. Concomitant use with other medications that have potential to increase the risk of cardiotoxicity should be avoided.

  7 sources

  1. "Product Information. Nizoral (ketoconazole)." Janssen Pharmaceuticals (2001):
  2. "Product Information. Diflucan (fluconazole)." Roerig Division (2002):
  3. "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals (2002):
  4. "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals (2022):
  5. "Product Information. VFEND (voriconazole)." Pfizer U.S. Pharmaceuticals (2002):
  6. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):
  7. "Product Information. Tolsura (itraconazole)." Mayne Pharma Inc (2021):