Drug interactions
Ketoconazole + Ramelteon
Severity: Moderate
Ketoconazole and Ramelteon: moderate 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 ramelteon exposure, which may cause excess sedation, dizziness and next-day somnolence.
What this interaction means in plain words
Ketoconazole and Ramelteon can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Ketoconazole belongs to Anti Fungals; Ramelteon belongs to Central Nervous System.
Why it happens
Ketoconazole inhibits CYP3A4, a secondary pathway of ramelteon metabolism.
What to do
Monitor for excessive sedation and consider using a lower ramelteon dose while ketoconazole is given.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Ramelteon
- Calcium / magnesium / potassium / sodium oxybates + Ramelteon Contraindicated
- Fluvoxamine + Ramelteon Contraindicated
- Ramelteon + Sodium oxybate Contraindicated
- Alfentanil + Ramelteon Moderate
- Amitriptyline + Ramelteon Moderate
- Amobarbital + Ramelteon Moderate
Frequently asked questions
Can I take Ketoconazole with Ramelteon?
MediHelp rates the interaction as moderate. Ketoconazole and Ramelteon can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Ketoconazole substantially increases ramelteon exposure, which may cause excess sedation, dizziness and next-day somnolence.
How serious is the interaction between Ketoconazole and Ramelteon?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for excessive sedation and consider using a lower ramelteon dose while ketoconazole is given.
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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