Drug interactions
Brexpiprazole + Levoketoconazole
Severity: Major
Brexpiprazole 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 inhibits both CYP3A4 strongly and CYP2D6 to a lesser degree, the two main routes of brexpiprazole clearance. Brexpiprazole exposure can therefore rise considerably, increasing dose-related adverse effects.
What this interaction means in plain words
Brexpiprazole 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.
Brexpiprazole belongs to Central Nervous System; Levoketoconazole belongs to Endocrine.
Why it happens
Combined inhibition of CYP3A4 and CYP2D6 metabolism of brexpiprazole.
What to do
Reduce brexpiprazole to a quarter of the usual dose while taking levoketoconazole, and monitor for adverse effects. Restore the dose after levoketoconazole 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 Brexpiprazole
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 Brexpiprazole with Levoketoconazole?
MediHelp rates the interaction as major. Brexpiprazole 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 inhibits both CYP3A4 strongly and CYP2D6 to a lesser degree, the two main routes of brexpiprazole clearance. Brexpiprazole exposure can therefore rise considerably, increasing dose-related adverse effects.
How serious is the interaction between Brexpiprazole 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 brexpiprazole to a quarter of the usual dose while taking levoketoconazole, and monitor for adverse effects. Restore the dose after levoketoconazole is stopped.
What other medicines interact with Brexpiprazole?
MediHelp also lists interactions of Brexpiprazole with, for example, Alfentanil, Amisulpride, Apalutamide. The full list is on the Brexpiprazole page.
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