Drug interactions
Ketoconazole + Sunitinib
Severity: Major
Ketoconazole and Sunitinib: 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 markedly raises sunitinib and its active metabolite exposure. This can increase toxicities such as hepatotoxicity, QT prolongation, myelosuppression, hypertension and fatigue.
What this interaction means in plain words
Ketoconazole and Sunitinib 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; Sunitinib belongs to Oncology.
Why it happens
Ketoconazole is a strong CYP3A4 inhibitor that reduces the metabolic clearance of sunitinib.
What to do
Prefer an antifungal or other agent without strong CYP3A4 inhibition. If unavoidable, reduce the sunitinib dose per labeling and monitor for toxicity, liver tests and ECG.
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 Sunitinib
- Adagrasib + Sunitinib Major
- Amiodarone + Sunitinib Major
- Amisulpride + Sunitinib Major
- Anagrelide + Sunitinib Major
- Apalutamide + Sunitinib Major
- Arsenic trioxide + Sunitinib Major
Frequently asked questions
Can I take Ketoconazole with Sunitinib?
MediHelp rates the interaction as major. Ketoconazole and Sunitinib 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 markedly raises sunitinib and its active metabolite exposure. This can increase toxicities such as hepatotoxicity, QT prolongation, myelosuppression, hypertension and fatigue.
How serious is the interaction between Ketoconazole and Sunitinib?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer an antifungal or other agent without strong CYP3A4 inhibition. If unavoidable, reduce the sunitinib dose per labeling and monitor for toxicity, liver tests and ECG.
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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