Drug interactions
Fluticasone-salmeterol + Ketoconazole
Severity: Major
Fluticasone-salmeterol 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 is a strong CYP3A4 inhibitor and increases systemic salmeterol exposure, with greater cardiovascular effects and QT prolongation. It also raises fluticasone levels, which may cause systemic corticosteroid effects.
What this interaction means in plain words
Fluticasone-salmeterol 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.
Fluticasone-salmeterol belongs to Respiratory; Ketoconazole belongs to Anti Fungals.
Why it happens
CYP3A4 inhibition by ketoconazole reduces the metabolism of salmeterol and fluticasone.
What to do
Avoid co-use where possible and select an alternative antifungal. If needed, monitor ECG, potassium and heart rate, and watch for cortisol suppression.
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 Fluticasone-salmeterol
- Darunavir + Fluticasone-salmeterol Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Fluticasone-salmeterol Contraindicated
- Fluticasone-salmeterol + Fosamprenavir Contraindicated
- Fluticasone-salmeterol + Indinavir Contraindicated
- Fluticasone-salmeterol + Lopinavir Contraindicated
- Fluticasone-salmeterol + Nelfinavir Contraindicated
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 Fluticasone-salmeterol with Ketoconazole?
MediHelp rates the interaction as major. Fluticasone-salmeterol 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 is a strong CYP3A4 inhibitor and increases systemic salmeterol exposure, with greater cardiovascular effects and QT prolongation. It also raises fluticasone levels, which may cause systemic corticosteroid effects.
How serious is the interaction between Fluticasone-salmeterol 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 co-use where possible and select an alternative antifungal. If needed, monitor ECG, potassium and heart rate, and watch for cortisol suppression.
What other medicines interact with Fluticasone-salmeterol?
MediHelp also lists interactions of Fluticasone-salmeterol with, for example, Darunavir, Elvitegravir / cobicistat / emtricitabine / tenofovir df, Fosamprenavir. The full list is on the Fluticasone-salmeterol page.
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