Drug interactions
Ketoconazole + Nevirapine
Severity: Major
Ketoconazole and Nevirapine: 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
Nevirapine induces ketoconazole metabolism and lowers its levels, risking antifungal failure, while ketoconazole raises nevirapine concentrations, increasing hepatotoxicity risk. Both drugs are hepatotoxic. Labeling advises against coadministration.
What this interaction means in plain words
Ketoconazole and Nevirapine 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; Nevirapine belongs to Anti Virals.
Why it happens
Nevirapine induces CYP3A4, lowering ketoconazole, while ketoconazole inhibits CYP3A4 and raises nevirapine.
What to do
Avoid the combination and use an alternative antifungal. If unavoidable, monitor liver function and clinical antifungal response 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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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 Nevirapine
- Elbasvir / grazoprevir + Nevirapine Contraindicated
- Nevirapine + Ranolazine Contraindicated
- Nevirapine + St john's wort Contraindicated
- Abemaciclib + Nevirapine Major
- Acalabrutinib + Nevirapine Major
- Amobarbital + Nevirapine Major
Frequently asked questions
Can I take Ketoconazole with Nevirapine?
MediHelp rates the interaction as major. Ketoconazole and Nevirapine 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. Nevirapine induces ketoconazole metabolism and lowers its levels, risking antifungal failure, while ketoconazole raises nevirapine concentrations, increasing hepatotoxicity risk. Both drugs are hepatotoxic. Labeling advises against coadministration.
How serious is the interaction between Ketoconazole and Nevirapine?
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 and use an alternative antifungal. If unavoidable, monitor liver function and clinical antifungal response closely.
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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