Drug interactions
Ketoconazole + Lemborexant
Severity: Major
Ketoconazole and Lemborexant: 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 increases lemborexant exposure, increasing the risk of next-day somnolence, impaired driving and other CNS effects.
What this interaction means in plain words
Ketoconazole and Lemborexant 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 belongs to Anti Fungals; Lemborexant belongs to Central Nervous System.
Why it happens
Strong CYP3A4 inhibition by ketoconazole markedly lowers lemborexant clearance.
What to do
Avoid concomitant use; labeling recommends avoiding strong and moderate CYP3A inhibitors. Use an alternative hypnotic or antifungal.
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 Lemborexant
Frequently asked questions
Can I take Ketoconazole with Lemborexant?
MediHelp rates the interaction as major. Ketoconazole and Lemborexant 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 increases lemborexant exposure, increasing the risk of next-day somnolence, impaired driving and other CNS effects.
How serious is the interaction between Ketoconazole and Lemborexant?
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 concomitant use; labeling recommends avoiding strong and moderate CYP3A inhibitors. Use an alternative hypnotic or antifungal.
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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