Drug interactions
Ketoconazole + Rabeprazole
Severity: Major
Ketoconazole and Rabeprazole: 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 requires an acidic stomach to dissolve and be absorbed. Rabeprazole can markedly lower ketoconazole exposure and cause antifungal treatment failure.
What this interaction means in plain words
Ketoconazole and Rabeprazole 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; Rabeprazole belongs to Gastrointestinal Tract.
Why it happens
Raised gastric pH impairs dissolution and absorption of ketoconazole tablets.
What to do
Avoid the combination if possible. If acid suppression is essential, consider an alternative antifungal that does not rely on acidity, such as fluconazole, and monitor clinical response.
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 Rabeprazole
- Rabeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Rabeprazole Major
- Atazanavir + Rabeprazole Major
- Dacomitinib + Rabeprazole Major
- Dasatinib + Rabeprazole Major
- Erlotinib + Rabeprazole Major
Other interactions of Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
Frequently asked questions
Can I take Ketoconazole with Rabeprazole?
MediHelp rates the interaction as major. Ketoconazole and Rabeprazole 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 requires an acidic stomach to dissolve and be absorbed. Rabeprazole can markedly lower ketoconazole exposure and cause antifungal treatment failure.
How serious is the interaction between Ketoconazole and Rabeprazole?
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 possible. If acid suppression is essential, consider an alternative antifungal that does not rely on acidity, such as fluconazole, and monitor clinical response.
What other medicines interact with Rabeprazole?
MediHelp also lists interactions of Rabeprazole with, for example, Rilpivirine, Acalabrutinib, Atazanavir. The full list is on the Rabeprazole page.
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