Drug interactions
Ibrutinib + Ketoconazole
Severity: Major
Ibrutinib 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 markedly increases ibrutinib exposure, which raises the risk of bleeding, infection, cytopenias and atrial fibrillation. Labeling advises against combining ibrutinib with strong CYP3A inhibitors.
What this interaction means in plain words
Ibrutinib 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.
Ibrutinib belongs to Oncology; Ketoconazole belongs to Anti Fungals.
Why it happens
Strong CYP3A4 inhibition by ketoconazole reduces the first-pass and systemic metabolism of ibrutinib.
What to do
Avoid the combination and use an antifungal with less CYP3A inhibition. If a strong inhibitor is needed short term, interrupt ibrutinib for the duration of the course, otherwise follow labeled dose reductions and monitor for toxicity.
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 Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
Other interactions of Ibrutinib
- Abciximab + Ibrutinib Major
- Acetylsalicylic acid + Ibrutinib Major
- Alteplase + Ibrutinib Major
- Amobarbital + Ibrutinib Major
- Apalutamide + Ibrutinib Major
- Apixaban + Ibrutinib Major
Frequently asked questions
Can I take Ibrutinib with Ketoconazole?
MediHelp rates the interaction as major. Ibrutinib 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 markedly increases ibrutinib exposure, which raises the risk of bleeding, infection, cytopenias and atrial fibrillation. Labeling advises against combining ibrutinib with strong CYP3A inhibitors.
How serious is the interaction between Ibrutinib 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 the combination and use an antifungal with less CYP3A inhibition. If a strong inhibitor is needed short term, interrupt ibrutinib for the duration of the course, otherwise follow labeled dose reductions and monitor for toxicity.
What other medicines interact with Ketoconazole?
MediHelp also lists interactions of Ketoconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Ketoconazole page.
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