Drug interactions
Ketoconazole + Ribociclib
Severity: Major
Ketoconazole and Ribociclib: 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 ribociclib exposure and both drugs can prolong the QT interval. This increases the risk of arrhythmia and ribociclib toxicity such as neutropenia and hepatotoxicity.
What this interaction means in plain words
Ketoconazole and Ribociclib 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; Ribociclib belongs to Oncology.
Why it happens
Strong CYP3A4 inhibition raises ribociclib levels, with additive QT prolongation.
What to do
Avoid the combination. If unavoidable, reduce the ribociclib starting dose to the labeled lower dose and monitor ECG, electrolytes and liver tests.
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 Ribociclib
- Amiodarone + Ribociclib Contraindicated
- Cisapride + Ribociclib Contraindicated
- Dofetilide + Ribociclib Contraindicated
- Dronedarone + Ribociclib Contraindicated
- Flibanserin + Ribociclib Contraindicated
- Ibutilide + Ribociclib Contraindicated
Frequently asked questions
Can I take Ketoconazole with Ribociclib?
MediHelp rates the interaction as major. Ketoconazole and Ribociclib 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 ribociclib exposure and both drugs can prolong the QT interval. This increases the risk of arrhythmia and ribociclib toxicity such as neutropenia and hepatotoxicity.
How serious is the interaction between Ketoconazole and Ribociclib?
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 unavoidable, reduce the ribociclib starting dose to the labeled lower dose and monitor ECG, electrolytes and liver tests.
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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