Drug interactions
Hydrocortisone + Ketoconazole
Severity: Major
Hydrocortisone 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 strongly inhibits CYP3A4 and P-glycoprotein and can substantially raise hydrocortisone exposure, causing Cushingoid effects and prolonged adrenal suppression. Ketoconazole also inhibits adrenal steroid synthesis, which complicates the clinical picture.
What this interaction means in plain words
Hydrocortisone 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.
Hydrocortisone belongs to Endocrine; Ketoconazole belongs to Anti Fungals.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein by ketoconazole reduces hydrocortisone clearance, alongside inhibition of adrenal steroidogenesis.
What to do
Reduce the hydrocortisone dose and monitor for corticosteroid excess and adrenal insufficiency; in replacement therapy, adjust to clinical response and be alert for adrenal crisis.
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 Hydrocortisone
- Hydrocortisone + Mifepristone Contraindicated
- Hydrocortisone + Poliovirus vaccine live oral trivalent Contraindicated
- Hydrocortisone + Smallpox vaccine live Contraindicated
- Adenovirus types 4 and 7 live + Hydrocortisone Major
- Aldesleukin + Hydrocortisone Major
- Aspirin + Hydrocortisone 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 Hydrocortisone with Ketoconazole?
MediHelp rates the interaction as major. Hydrocortisone 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 strongly inhibits CYP3A4 and P-glycoprotein and can substantially raise hydrocortisone exposure, causing Cushingoid effects and prolonged adrenal suppression. Ketoconazole also inhibits adrenal steroid synthesis, which complicates the clinical picture.
How serious is the interaction between Hydrocortisone 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: Reduce the hydrocortisone dose and monitor for corticosteroid excess and adrenal insufficiency; in replacement therapy, adjust to clinical response and be alert for adrenal crisis.
What other medicines interact with Hydrocortisone?
MediHelp also lists interactions of Hydrocortisone with, for example, Mifepristone, Poliovirus vaccine live oral trivalent, Smallpox vaccine live. The full list is on the Hydrocortisone page.
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