Drug interactions
Cilostazol + Levoketoconazole
Severity: Major
Cilostazol 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 increases cilostazol exposure. This may cause tachycardia, palpitations and headache, and raises concern in patients with cardiac disease.
What this interaction means in plain words
Cilostazol 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.
Cilostazol belongs to Cardiovascular; Levoketoconazole belongs to Endocrine.
Why it happens
Levoketoconazole strongly inhibits CYP3A4, reducing cilostazol metabolism.
What to do
Reduce cilostazol to 50 mg twice daily during co-treatment, and monitor heart rate and tolerability. Note that levoketoconazole also prolongs QT, so ECG monitoring is advisable.
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 Cilostazol
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 Cilostazol with Levoketoconazole?
MediHelp rates the interaction as major. Cilostazol 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 increases cilostazol exposure. This may cause tachycardia, palpitations and headache, and raises concern in patients with cardiac disease.
How serious is the interaction between Cilostazol 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 cilostazol to 50 mg twice daily during co-treatment, and monitor heart rate and tolerability. Note that levoketoconazole also prolongs QT, so ECG monitoring is advisable.
What other medicines interact with Cilostazol?
MediHelp also lists interactions of Cilostazol with, for example, Abrocitinib, Anagrelide, Betrixaban. The full list is on the Cilostazol page.
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