Drug interactions
Dabigatran etexilate + Ketoconazole
Severity: Major
Dabigatran etexilate 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 raises dabigatran plasma concentrations, which increases bleeding risk, especially in patients with reduced renal function. The effect is greater when kidney clearance is already impaired.
What this interaction means in plain words
Dabigatran etexilate 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.
Dabigatran etexilate belongs to Cardiovascular; Ketoconazole belongs to Anti Fungals.
Why it happens
Ketoconazole inhibits intestinal and renal P-glycoprotein, increasing dabigatran absorption and reducing its elimination.
What to do
Follow labeled renal-function-based recommendations: avoid the combination at lower creatinine clearance and consider dose reduction in moderate impairment. Monitor for bleeding and consider an alternative antifungal.
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 Dabigatran etexilate
- Dabigatran etexilate + Defibrotide Contraindicated
- Dabigatran etexilate + Ketorolac Contraindicated
- Dabigatran etexilate + Mifepristone Contraindicated
- Abciximab + Dabigatran etexilate Major
- Alteplase + Dabigatran etexilate Major
- Amiodarone + Dabigatran etexilate Major
Other interactions of Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
Frequently asked questions
Can I take Dabigatran etexilate with Ketoconazole?
MediHelp rates the interaction as major. Dabigatran etexilate 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 raises dabigatran plasma concentrations, which increases bleeding risk, especially in patients with reduced renal function. The effect is greater when kidney clearance is already impaired.
How serious is the interaction between Dabigatran etexilate 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: Follow labeled renal-function-based recommendations: avoid the combination at lower creatinine clearance and consider dose reduction in moderate impairment. Monitor for bleeding and consider an alternative antifungal.
What other medicines interact with Dabigatran etexilate?
MediHelp also lists interactions of Dabigatran etexilate with, for example, Defibrotide, Ketorolac, Mifepristone. The full list is on the Dabigatran etexilate page.
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