Drug interactions
Apixaban + Levoketoconazole
Severity: Major
Apixaban and Levoketoconazole: major interaction.
Last updated Sources: US FDA label
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
Levoketoconazole, the active enantiomer of ketoconazole, strongly inhibits CYP3A4 and P-gp. This raises apixaban exposure and the risk of major bleeding.
What this interaction means in plain words
Apixaban 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.
Apixaban belongs to Cardiovascular; Levoketoconazole belongs to Endocrine.
Why it happens
Combined inhibition of CYP3A4 and P-gp reduces apixaban metabolism and efflux.
What to do
Reduce apixaban by 50% if the dose is above 2.5 mg twice daily. Avoid the combination if the patient already takes 2.5 mg twice daily, and monitor for bleeding.
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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References
Other interactions of Apixaban
- Apixaban + Dabigatran Contraindicated
- Apixaban + Defibrotide Contraindicated
- Apixaban + Edoxaban Contraindicated
- Apixaban + Ketorolac Contraindicated
- Apixaban + Mifepristone Contraindicated
- Abciximab + Apixaban Major
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 Apixaban with Levoketoconazole?
MediHelp rates the interaction as major. Apixaban 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. Levoketoconazole, the active enantiomer of ketoconazole, strongly inhibits CYP3A4 and P-gp. This raises apixaban exposure and the risk of major bleeding.
How serious is the interaction between Apixaban 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: Reduce apixaban by 50% if the dose is above 2.5 mg twice daily. Avoid the combination if the patient already takes 2.5 mg twice daily, and monitor for bleeding.
What other medicines interact with Apixaban?
MediHelp also lists interactions of Apixaban with, for example, Dabigatran, Defibrotide, Edoxaban. The full list is on the Apixaban page.
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