Drug interactions
Amitriptyline + Levoketoconazole
Severity: Major
Amitriptyline and Levoketoconazole: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Both drugs prolong the QT interval, and levoketoconazole also inhibits CYP3A4 and CYP2D6, which can raise amitriptyline exposure. The combination increases the risk of torsades de pointes, particularly with electrolyte disturbances or underlying heart disease.
What this interaction means in plain words
Amitriptyline and Levoketoconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Amitriptyline belongs to Central Nervous System; Levoketoconazole belongs to Endocrine.
Why it happens
Additive QT prolongation, plus levoketoconazole-mediated inhibition of CYP enzymes that metabolise amitriptyline.
What to do
Avoid the combination where possible and choose a non-QT-prolonging antidepressant. If unavoidable, obtain a baseline and follow-up ECG, correct potassium and magnesium, and monitor for arrhythmia.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Other interactions of Levoketoconazole
- Alfuzosin + Levoketoconazole Contraindicated
- Alprazolam + Levoketoconazole Contraindicated
- Amiodarone + Levoketoconazole Contraindicated
- Avanafil + Levoketoconazole Contraindicated
- Cisapride + Levoketoconazole Contraindicated
- Clarithromycin + Levoketoconazole Contraindicated
Frequently asked questions
Can I take Amitriptyline with Levoketoconazole?
MediHelp rates the interaction as major. Amitriptyline and Levoketoconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Both drugs prolong the QT interval, and levoketoconazole also inhibits CYP3A4 and CYP2D6, which can raise amitriptyline exposure. The combination increases the risk of torsades de pointes, particularly with electrolyte disturbances or underlying heart disease.
How serious is the interaction between Amitriptyline and Levoketoconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and choose a non-QT-prolonging antidepressant. If unavoidable, obtain a baseline and follow-up ECG, correct potassium and magnesium, and monitor for arrhythmia.
What other medicines interact with Amitriptyline?
MediHelp also lists interactions of Amitriptyline with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Amitriptyline page.
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