Drug interactions
Esomeprazole + Levoketoconazole
Severity: Major
Esomeprazole and Levoketoconazole: 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
Levoketoconazole requires an acidic environment for dissolution, so esomeprazole may reduce its absorption. This could weaken its cortisol-lowering effect in Cushing syndrome.
What this interaction means in plain words
Esomeprazole 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.
Esomeprazole belongs to Gastrointestinal Tract; Levoketoconazole belongs to Endocrine.
Why it happens
Higher gastric pH reduces the dissolution and absorption of levoketoconazole.
What to do
Avoid PPIs with levoketoconazole. If acid suppression is needed, use a short-acting antacid taken at least 2 hours after levoketoconazole, and monitor cortisol control.
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 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 Esomeprazole with Levoketoconazole?
MediHelp rates the interaction as major. Esomeprazole 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 requires an acidic environment for dissolution, so esomeprazole may reduce its absorption. This could weaken its cortisol-lowering effect in Cushing syndrome.
How serious is the interaction between Esomeprazole 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: Avoid PPIs with levoketoconazole. If acid suppression is needed, use a short-acting antacid taken at least 2 hours after levoketoconazole, and monitor cortisol control.
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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