Drug interactions
Itraconazole + Ombitasvir / paritaprevir / ritonavir
Severity: Major
Itraconazole and Ombitasvir / paritaprevir / ritonavir: 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
Itraconazole and the ritonavir-boosted regimen inhibit CYP3A4 and each other's elimination. Itraconazole exposure rises and paritaprevir and ritonavir exposure may also increase, raising the risk of toxicity including hepatic effects and QT-related events.
What this interaction means in plain words
Itraconazole and Ombitasvir / paritaprevir / ritonavir 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
Mutual CYP3A4 and P-glycoprotein inhibition; ritonavir is a potent CYP3A4 inhibitor and itraconazole is a CYP3A4 substrate and inhibitor.
What to do
Avoid high itraconazole doses; labeling advises limiting itraconazole dose and monitoring concentrations. Consider an alternative antifungal such as voriconazole only with appropriate assessment, or monitor ECG and liver tests closely.
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 Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole Contraindicated
Frequently asked questions
Can I take Itraconazole with Ombitasvir / paritaprevir / ritonavir?
MediHelp rates the interaction as major. Itraconazole and Ombitasvir / paritaprevir / ritonavir 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. Itraconazole and the ritonavir-boosted regimen inhibit CYP3A4 and each other's elimination. Itraconazole exposure rises and paritaprevir and ritonavir exposure may also increase, raising the risk of toxicity including hepatic effects and QT-related events.
How serious is the interaction between Itraconazole and Ombitasvir / paritaprevir / ritonavir?
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 high itraconazole doses; labeling advises limiting itraconazole dose and monitoring concentrations. Consider an alternative antifungal such as voriconazole only with appropriate assessment, or monitor ECG and liver tests closely.
What other medicines interact with Itraconazole?
MediHelp also lists interactions of Itraconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Itraconazole page.
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