Drug interactions
Ketoconazole + Sotalol
Severity: Major
Ketoconazole and Sotalol: 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
Both drugs can prolong the QT interval, so combined use raises the risk of torsades de pointes. Sotalol is not metabolized by CYP3A4, so the concern is pharmacodynamic. Risk is higher with hypokalemia, bradycardia or renal impairment.
What this interaction means in plain words
Ketoconazole and Sotalol 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; Sotalol belongs to Cardiovascular.
Why it happens
Additive prolongation of cardiac repolarization through potassium channel blockade.
What to do
Avoid if possible and use an antifungal without QT effects. If necessary, obtain a baseline and follow-up ECG and correct potassium and magnesium.
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 Sotalol
- Arsenic trioxide + Sotalol Contraindicated
- Artemether / lumefantrine + Sotalol Contraindicated
- Disopyramide + Sotalol Contraindicated
- Dofetilide + Sotalol Contraindicated
- Dronedarone + Sotalol Contraindicated
- Droperidol + Sotalol Contraindicated
Frequently asked questions
Can I take Ketoconazole with Sotalol?
MediHelp rates the interaction as major. Ketoconazole and Sotalol 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. Both drugs can prolong the QT interval, so combined use raises the risk of torsades de pointes. Sotalol is not metabolized by CYP3A4, so the concern is pharmacodynamic. Risk is higher with hypokalemia, bradycardia or renal impairment.
How serious is the interaction between Ketoconazole and Sotalol?
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 if possible and use an antifungal without QT effects. If necessary, obtain a baseline and follow-up ECG and correct potassium and magnesium.
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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