Drug interactions
Bosentan + Ketoconazole
Severity: Moderate
Bosentan and Ketoconazole: moderate 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
Ketoconazole raises bosentan exposure, which increases the risk of dose-related adverse effects such as liver enzyme elevation, headache, flushing and edema. The effect is moderate with ketoconazole, and stronger inhibitor combinations are more concerning.
What this interaction means in plain words
Bosentan and Ketoconazole can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Bosentan belongs to Miscellaneous; Ketoconazole belongs to Anti Fungals.
Why it happens
Ketoconazole inhibits CYP3A4, which is involved in bosentan metabolism, reducing its clearance.
What to do
Monitor liver function tests and signs of bosentan toxicity such as hypotension and edema. Reduce the bosentan dose if adverse effects develop.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan Major
Frequently asked questions
Can I take Bosentan with Ketoconazole?
MediHelp rates the interaction as moderate. Bosentan and Ketoconazole can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Ketoconazole raises bosentan exposure, which increases the risk of dose-related adverse effects such as liver enzyme elevation, headache, flushing and edema. The effect is moderate with ketoconazole, and stronger inhibitor combinations are more concerning.
How serious is the interaction between Bosentan and Ketoconazole?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor liver function tests and signs of bosentan toxicity such as hypotension and edema. Reduce the bosentan dose if adverse effects develop.
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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