Drug interactions
Ketoconazole + Salmeterol
Severity: Major
Ketoconazole and Salmeterol: 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 strongly inhibits CYP3A4 and substantially increases salmeterol exposure, raising the risk of tachycardia, palpitations, hypokalemia and QT prolongation. Ketoconazole also prolongs QT.
What this interaction means in plain words
Ketoconazole and Salmeterol 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; Salmeterol belongs to Respiratory.
Why it happens
Strong CYP3A4 inhibition reduces first-pass and systemic clearance of salmeterol.
What to do
Avoid co-administration where possible and choose an alternative bronchodilator or antifungal. If unavoidable, monitor ECG, heart rate and potassium.
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 Salmeterol
- Ritonavir + Salmeterol Contraindicated
- Salmeterol + Saquinavir Contraindicated
- Amitriptyline + Salmeterol Major
- Arformoterol + Salmeterol Major
- Atazanavir + Salmeterol Major
- Budesonide-formoterol + Salmeterol 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 Salmeterol?
MediHelp rates the interaction as major. Ketoconazole and Salmeterol 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 strongly inhibits CYP3A4 and substantially increases salmeterol exposure, raising the risk of tachycardia, palpitations, hypokalemia and QT prolongation. Ketoconazole also prolongs QT.
How serious is the interaction between Ketoconazole and Salmeterol?
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 co-administration where possible and choose an alternative bronchodilator or antifungal. If unavoidable, monitor ECG, heart rate and potassium.
What other medicines interact with Salmeterol?
MediHelp also lists interactions of Salmeterol with, for example, Ritonavir, Saquinavir, Amitriptyline. The full list is on the Salmeterol page.
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