Drug interactions
Iloperidone + Ketoconazole
Severity: Major
Iloperidone 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 raises iloperidone concentrations, increasing risk of QT prolongation, sedation and orthostatic hypotension. Iloperidone already carries QT risk, and ketoconazole itself can prolong QT.
What this interaction means in plain words
Iloperidone 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.
Iloperidone belongs to Central Nervous System; Ketoconazole belongs to Anti Fungals.
Why it happens
Ketoconazole inhibits CYP3A4 (and CYP2D6 contributes) metabolism of iloperidone, and both drugs have additive QT effects.
What to do
Reduce the iloperidone dose by about half when giving a strong CYP3A4 inhibitor and monitor ECG and electrolytes. Prefer a non-interacting antifungal.
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 Iloperidone
- Iloperidone + Thioridazine Contraindicated
- Alfuzosin + Iloperidone Major
- Amiodarone + Iloperidone Major
- Amisulpride + Iloperidone Major
- Amitriptyline + Iloperidone Major
- Anagrelide + Iloperidone Major
Frequently asked questions
Can I take Iloperidone with Ketoconazole?
MediHelp rates the interaction as major. Iloperidone 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 raises iloperidone concentrations, increasing risk of QT prolongation, sedation and orthostatic hypotension. Iloperidone already carries QT risk, and ketoconazole itself can prolong QT.
How serious is the interaction between Iloperidone 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 iloperidone dose by about half when giving a strong CYP3A4 inhibitor and monitor ECG and electrolytes. Prefer a non-interacting antifungal.
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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