Drug interactions
Clopidogrel + Ketoconazole
Severity: Moderate
Clopidogrel and Ketoconazole: moderate 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 reduce formation of clopidogrel's active metabolite, potentially weakening platelet inhibition. The clinical consequence is uncertain but could include reduced protection against thrombotic events.
What this interaction means in plain words
Clopidogrel and Ketoconazole can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Clopidogrel belongs to Cardiovascular; Ketoconazole belongs to Anti Fungals.
Why it happens
Ketoconazole inhibits CYP3A4 and possibly CYP2C19, which contribute to bioactivation of clopidogrel.
What to do
Consider an alternative antifungal with less CYP inhibition if clopidogrel efficacy is critical, such as after stent placement. Otherwise monitor for thrombotic events or consider platelet function testing.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Clopidogrel
Frequently asked questions
Can I take Clopidogrel with Ketoconazole?
MediHelp rates the interaction as moderate. Clopidogrel and Ketoconazole can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Ketoconazole may reduce formation of clopidogrel's active metabolite, potentially weakening platelet inhibition. The clinical consequence is uncertain but could include reduced protection against thrombotic events.
How serious is the interaction between Clopidogrel and Ketoconazole?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Consider an alternative antifungal with less CYP inhibition if clopidogrel efficacy is critical, such as after stent placement. Otherwise monitor for thrombotic events or consider platelet function testing.
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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