Drug interactions
Aripiprazole + Ketoconazole
Severity: Major
Aripiprazole and Ketoconazole: 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
Aripiprazole is cleared by CYP3A4 and CYP2D6, and ketoconazole is a strong CYP3A4 inhibitor that substantially raises aripiprazole levels. This can increase akathisia, sedation, orthostatic hypotension and extrapyramidal effects.
What this interaction means in plain words
Aripiprazole and Ketoconazole 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.
Aripiprazole belongs to Central Nervous System; Ketoconazole belongs to Anti Fungals.
Why it happens
Ketoconazole inhibits CYP3A4, reducing aripiprazole clearance.
What to do
Reduce the aripiprazole dose to about half the usual dose during ketoconazole therapy, and lower it further if a CYP2D6 inhibitor is also used. Return to the usual dose after ketoconazole is stopped.
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 Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
Other interactions of Aripiprazole
- Aripiprazole + Pimozide Contraindicated
- Aripiprazole + Thioridazine Contraindicated
- Amisulpride + Aripiprazole Major
- Aripiprazole + Arsenic trioxide Major
- Aripiprazole + Calcium / magnesium / potassium / sodium oxybates Major
- Aripiprazole + Carbamazepine Major
Frequently asked questions
Can I take Aripiprazole with Ketoconazole?
MediHelp rates the interaction as major. Aripiprazole and Ketoconazole 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. Aripiprazole is cleared by CYP3A4 and CYP2D6, and ketoconazole is a strong CYP3A4 inhibitor that substantially raises aripiprazole levels. This can increase akathisia, sedation, orthostatic hypotension and extrapyramidal effects.
How serious is the interaction between Aripiprazole and Ketoconazole?
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 the aripiprazole dose to about half the usual dose during ketoconazole therapy, and lower it further if a CYP2D6 inhibitor is also used. Return to the usual dose after ketoconazole is stopped.
What other medicines interact with Ketoconazole?
MediHelp also lists interactions of Ketoconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Ketoconazole page.
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