Drug interactions
Bosentan + Levoketoconazole
Severity: Major
Bosentan 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 is a strong CYP3A4 inhibitor and can raise bosentan exposure. Ketoconazole increases bosentan levels, raising hepatotoxicity risk, and levoketoconazole itself is hepatotoxic. Together they increase the chance of liver injury.
What this interaction means in plain words
Bosentan 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.
Bosentan belongs to Miscellaneous; Levoketoconazole belongs to Endocrine.
Why it happens
Levoketoconazole inhibits CYP3A4 metabolism of bosentan, increasing its plasma concentration.
What to do
Avoid if possible; otherwise monitor liver enzymes closely and watch for hypotension and edema, and consider a bosentan dose reduction.
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 Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan 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 Bosentan with Levoketoconazole?
MediHelp rates the interaction as major. Bosentan 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 is a strong CYP3A4 inhibitor and can raise bosentan exposure. Ketoconazole increases bosentan levels, raising hepatotoxicity risk, and levoketoconazole itself is hepatotoxic. Together they increase the chance of liver injury.
How serious is the interaction between Bosentan 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 if possible; otherwise monitor liver enzymes closely and watch for hypotension and edema, and consider a bosentan dose reduction.
What other medicines interact with Bosentan?
MediHelp also lists interactions of Bosentan with, for example, Cyclosporin, Glibenclamide, Glyburide-metformin. The full list is on the Bosentan page.
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