Drug interactions
Ketoconazole + Pimavanserin
Severity: Major
Ketoconazole and Pimavanserin: 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 increases pimavanserin exposure, and pimavanserin itself prolongs the QT interval, so higher levels increase arrhythmia risk.
What this interaction means in plain words
Ketoconazole and Pimavanserin 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; Pimavanserin belongs to Central Nervous System.
Why it happens
Strong CYP3A4 inhibition reduces pimavanserin clearance.
What to do
Reduce the pimavanserin dose to the labeled lower dose if a strong CYP3A4 inhibitor is needed, and monitor the ECG. Prefer a non-inhibiting antifungal where possible.
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 Pimavanserin
- Lefamulin + Pimavanserin Contraindicated
- Pimavanserin + Pimozide Contraindicated
- Pimavanserin + Vandetanib Contraindicated
- Adagrasib + Pimavanserin Major
- Amiodarone + Pimavanserin Major
- Amisulpride + Pimavanserin Major
Frequently asked questions
Can I take Ketoconazole with Pimavanserin?
MediHelp rates the interaction as major. Ketoconazole and Pimavanserin 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 pimavanserin exposure, and pimavanserin itself prolongs the QT interval, so higher levels increase arrhythmia risk.
How serious is the interaction between Ketoconazole and Pimavanserin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce the pimavanserin dose to the labeled lower dose if a strong CYP3A4 inhibitor is needed, and monitor the ECG. Prefer a non-inhibiting antifungal where possible.
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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