Drug interactions
Imipramine + Ketoconazole
Severity: Major
Imipramine 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
Both agents can prolong the QT interval, and ketoconazole may modestly raise tricyclic concentrations by inhibiting CYP-mediated metabolism. This increases the risk of arrhythmia, anticholinergic effects and other tricyclic toxicity.
What this interaction means in plain words
Imipramine 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.
Imipramine belongs to Central Nervous System; Ketoconazole belongs to Anti Fungals.
Why it happens
Additive QT prolongation with possible CYP inhibition by ketoconazole reducing imipramine clearance.
What to do
Avoid the combination if possible, or obtain an ECG and electrolytes at baseline and during therapy. Monitor for tricyclic toxicity and consider a lower imipramine dose or a different 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?
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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 Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide Contraindicated
Frequently asked questions
Can I take Imipramine with Ketoconazole?
MediHelp rates the interaction as major. Imipramine 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. Both agents can prolong the QT interval, and ketoconazole may modestly raise tricyclic concentrations by inhibiting CYP-mediated metabolism. This increases the risk of arrhythmia, anticholinergic effects and other tricyclic toxicity.
How serious is the interaction between Imipramine 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 if possible, or obtain an ECG and electrolytes at baseline and during therapy. Monitor for tricyclic toxicity and consider a lower imipramine dose or a different antidepressant.
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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