Drug interactions
Irinotecan + Levoketoconazole
Severity: Major
Irinotecan and Levoketoconazole: major interaction.
Last updated Sources: US FDA label
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
Levoketoconazole inhibits CYP3A4 and may inhibit UGT1A1, raising exposure to irinotecan and SN-38. Ketoconazole coadministration has been shown to increase SN-38 exposure and toxicity risk.
What this interaction means in plain words
Irinotecan and Levoketoconazole 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.
Irinotecan belongs to Oncology; Levoketoconazole belongs to Endocrine.
Why it happens
Inhibition of CYP3A4 and possibly UGT1A1 reduces inactivation and glucuronidation of irinotecan and SN-38.
What to do
Avoid the combination where possible. If necessary, monitor closely for severe diarrhoea and myelosuppression and consider dose reduction.
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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References
Other interactions of Irinotecan
- Clozapine + Irinotecan Contraindicated
- Irinotecan + Sacituzumab govitecan Contraindicated
- Adenovirus types 4 and 7 live + Irinotecan Major
- Apalutamide + Irinotecan Major
- Atazanavir + Irinotecan Major
- Carbamazepine + Irinotecan Major
Other interactions of Levoketoconazole
- Alfuzosin + Levoketoconazole Contraindicated
- Alprazolam + Levoketoconazole Contraindicated
- Amiodarone + Levoketoconazole Contraindicated
- Avanafil + Levoketoconazole Contraindicated
- Cisapride + Levoketoconazole Contraindicated
- Clarithromycin + Levoketoconazole Contraindicated
Frequently asked questions
Can I take Irinotecan with Levoketoconazole?
MediHelp rates the interaction as major. Irinotecan and Levoketoconazole 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. Levoketoconazole inhibits CYP3A4 and may inhibit UGT1A1, raising exposure to irinotecan and SN-38. Ketoconazole coadministration has been shown to increase SN-38 exposure and toxicity risk.
How serious is the interaction between Irinotecan and Levoketoconazole?
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 where possible. If necessary, monitor closely for severe diarrhoea and myelosuppression and consider dose reduction.
What other medicines interact with Irinotecan?
MediHelp also lists interactions of Irinotecan with, for example, Clozapine, Sacituzumab govitecan, Adenovirus types 4 and 7 live. The full list is on the Irinotecan page.
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