Drug interactions
Indinavir + Ketoconazole
Severity: Major
Indinavir 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 substantially raises indinavir plasma concentrations, increasing the risk of indinavir toxicity such as nephrolithiasis and hyperbilirubinemia. Labeling recommends lowering the indinavir dose.
What this interaction means in plain words
Indinavir 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.
Why it happens
Ketoconazole inhibits CYP3A4 (and P-glycoprotein), decreasing indinavir metabolism and efflux.
What to do
Reduce indinavir to 600 mg every 8 hours when given with ketoconazole. Maintain hydration and monitor renal function and bilirubin.
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
Frequently asked questions
Can I take Indinavir with Ketoconazole?
MediHelp rates the interaction as major. Indinavir 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 substantially raises indinavir plasma concentrations, increasing the risk of indinavir toxicity such as nephrolithiasis and hyperbilirubinemia. Labeling recommends lowering the indinavir dose.
How serious is the interaction between Indinavir 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 indinavir to 600 mg every 8 hours when given with ketoconazole. Maintain hydration and monitor renal function and bilirubin.
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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