Drug interactions
Ivosidenib + Ketoconazole
Severity: Major
Ivosidenib and Ketoconazole: 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
Ketoconazole increases ivosidenib exposure, which raises the risk of QTc prolongation and differentiation syndrome. Ketoconazole also has intrinsic QT effects.
What this interaction means in plain words
Ivosidenib 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.
Ivosidenib belongs to Oncology; Ketoconazole belongs to Anti Fungals.
Why it happens
Strong CYP3A4 inhibition by ketoconazole reduces ivosidenib clearance, with additive QT effects.
What to do
Avoid the combination; if unavoidable, reduce ivosidenib to 250 mg daily and monitor ECG and electrolytes. Return to the usual dose after the inhibitor has been stopped for at least 5 half-lives.
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 Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
Other interactions of Ivosidenib
- Alfuzosin + Ivosidenib Major
- Amiodarone + Ivosidenib Major
- Amisulpride + Ivosidenib Major
- Amitriptyline + Ivosidenib Major
- Amobarbital + Ivosidenib Major
- Anagrelide + Ivosidenib Major
Frequently asked questions
Can I take Ivosidenib with Ketoconazole?
MediHelp rates the interaction as major. Ivosidenib 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 increases ivosidenib exposure, which raises the risk of QTc prolongation and differentiation syndrome. Ketoconazole also has intrinsic QT effects.
How serious is the interaction between Ivosidenib 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 unavoidable, reduce ivosidenib to 250 mg daily and monitor ECG and electrolytes. Return to the usual dose after the inhibitor has been stopped for at least 5 half-lives.
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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