Drug interactions
Cholic acid + Ketoconazole
Severity: Major
Cholic acid and Ketoconazole: major 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 may inhibit the bile salt export pump, which cholic acid therapy depends on for hepatic bile salt excretion. Accumulation of conjugated bile salts in hepatocytes can cause liver injury.
What this interaction means in plain words
Cholic acid 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.
Cholic acid belongs to Gastrointestinal Tract; Ketoconazole belongs to Anti Fungals.
Why it happens
Inhibition of the bile salt efflux pump (BSEP) reduces hepatic bile salt elimination.
What to do
Avoid the combination where possible; if it is necessary, monitor serum transaminases and bilirubin regularly and stop cholic acid if liver injury develops.
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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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 Cholic acid
Frequently asked questions
Can I take Cholic acid with Ketoconazole?
MediHelp rates the interaction as major. Cholic acid 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. Ketoconazole may inhibit the bile salt export pump, which cholic acid therapy depends on for hepatic bile salt excretion. Accumulation of conjugated bile salts in hepatocytes can cause liver injury.
How serious is the interaction between Cholic acid 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: Avoid the combination where possible; if it is necessary, monitor serum transaminases and bilirubin regularly and stop cholic acid if liver injury develops.
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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