Drug interactions
Fluvoxamine + Levoketoconazole
Severity: Major
Fluvoxamine 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 prolongs the QT interval in a dose-related fashion and fluvoxamine has a smaller QT effect. Levoketoconazole is also a strong CYP3A4 inhibitor, and fluvoxamine inhibits CYP2C19, 1A2 and 3A4, which may raise exposure to either drug. The combination increases the risk of torsades de pointes.
What this interaction means in plain words
Fluvoxamine 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.
Fluvoxamine belongs to Central Nervous System; Levoketoconazole belongs to Endocrine.
Why it happens
Additive QT prolongation, with potential CYP-mediated increases in drug exposure.
What to do
Avoid if possible; otherwise obtain a baseline ECG, correct potassium and magnesium, and monitor QTc regularly. Levoketoconazole labeling requires caution with other QT-prolonging drugs, so consider an alternative antidepressant.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Fluvoxamine and Levoketoconazole, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
- Fezolinetant + Fluvoxamine Contraindicated
- Fluvoxamine + Isocarboxazid Contraindicated
- Fluvoxamine + Mavacamten Contraindicated
- Fluvoxamine + Methylene blue Contraindicated
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 Fluvoxamine with Levoketoconazole?
MediHelp rates the interaction as major. Fluvoxamine 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 prolongs the QT interval in a dose-related fashion and fluvoxamine has a smaller QT effect. Levoketoconazole is also a strong CYP3A4 inhibitor, and fluvoxamine inhibits CYP2C19, 1A2 and 3A4, which may raise exposure to either drug. The combination increases the risk of torsades de pointes.
How serious is the interaction between Fluvoxamine 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 if possible; otherwise obtain a baseline ECG, correct potassium and magnesium, and monitor QTc regularly. Levoketoconazole labeling requires caution with other QT-prolonging drugs, so consider an alternative antidepressant.
What other medicines interact with Fluvoxamine?
MediHelp also lists interactions of Fluvoxamine with, for example, Agomelatine, Alosetron, Fezolinetant. The full list is on the Fluvoxamine page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
