Drug interactions
Esomeprazole + Ketoconazole
Severity: Major
Esomeprazole and Ketoconazole: major interaction.
Last updated Sources: US FDA label
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 needs gastric acid to dissolve, so acid suppression markedly reduces its absorption and may cause antifungal failure. This matters most in serious or invasive infections.
What this interaction means in plain words
Esomeprazole 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.
Esomeprazole belongs to Gastrointestinal Tract; Ketoconazole belongs to Anti Fungals.
Why it happens
Elevated gastric pH reduces dissolution and absorption of oral ketoconazole.
What to do
Avoid combining with a PPI where possible and consider an alternative antifungal such as fluconazole. If unavoidable, monitor clinical response.
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 Esomeprazole
- Esomeprazole + Mavacamten Contraindicated
- Esomeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Esomeprazole Major
- Atazanavir + Esomeprazole Major
- Citalopram + Esomeprazole Major
- Clopidogrel + Esomeprazole 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 Esomeprazole with Ketoconazole?
MediHelp rates the interaction as major. Esomeprazole 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 needs gastric acid to dissolve, so acid suppression markedly reduces its absorption and may cause antifungal failure. This matters most in serious or invasive infections.
How serious is the interaction between Esomeprazole 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 combining with a PPI where possible and consider an alternative antifungal such as fluconazole. If unavoidable, monitor clinical response.
What other medicines interact with Esomeprazole?
MediHelp also lists interactions of Esomeprazole with, for example, Mavacamten, Rilpivirine, Acalabrutinib. The full list is on the Esomeprazole page.
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