Drug interactions
Cariprazine + Levoketoconazole
Severity: Major
Cariprazine and Levoketoconazole: major interaction.
Last updated Sources: UK SmPC
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 cariprazine and its active metabolites. This increases the risk of akathisia, extrapyramidal symptoms and sedation.
What this interaction means in plain words
Cariprazine 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.
Cariprazine belongs to Central Nervous System; Levoketoconazole belongs to Endocrine.
Why it happens
Inhibition of CYP3A4 by levoketoconazole reduces cariprazine metabolism.
What to do
Halve the cariprazine dose when combined with a strong CYP3A4 inhibitor and monitor for adverse effects for several weeks. Levoketoconazole may also prolong QT, so consider ECG monitoring.
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
- Reagila 1.5 mg hard capsules - SmPC sections 4.3/4.5 (class statement: strong CYP3A4 inhibitors; "co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, ") — electronic medicines compendium (UK SmPC)
Other interactions of Cariprazine
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 Cariprazine with Levoketoconazole?
MediHelp rates the interaction as major. Cariprazine 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 cariprazine and its active metabolites. This increases the risk of akathisia, extrapyramidal symptoms and sedation.
How serious is the interaction between Cariprazine 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: Halve the cariprazine dose when combined with a strong CYP3A4 inhibitor and monitor for adverse effects for several weeks. Levoketoconazole may also prolong QT, so consider ECG monitoring.
What other medicines interact with Cariprazine?
MediHelp also lists interactions of Cariprazine with, for example, Alfentanil, Amisulpride, Amobarbital. The full list is on the Cariprazine page.
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