Drug interactions
Ketoconazole + Topotecan
Severity: Major
Ketoconazole and Topotecan: 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 may increase topotecan exposure, particularly with oral topotecan, raising the risk of myelosuppression and gastrointestinal toxicity. The effect with intravenous topotecan is probably smaller.
What this interaction means in plain words
Ketoconazole and Topotecan 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; Topotecan belongs to Oncology.
Why it happens
Inhibition of P-glycoprotein (and possibly BCRP) increases topotecan absorption and reduces its elimination.
What to do
Avoid P-glycoprotein inhibitors with oral topotecan. If combined with the intravenous form, monitor blood counts closely.
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 Topotecan
- Adenovirus types 4 and 7 live + Topotecan Contraindicated
- Amiodarone + Topotecan Major
- Cisplatin + Topotecan Major
- Cobicistat + Topotecan Major
- Cyclosporine + Topotecan Major
- Cyclosporin + Topotecan Major
Frequently asked questions
Can I take Ketoconazole with Topotecan?
MediHelp rates the interaction as major. Ketoconazole and Topotecan 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 may increase topotecan exposure, particularly with oral topotecan, raising the risk of myelosuppression and gastrointestinal toxicity. The effect with intravenous topotecan is probably smaller.
How serious is the interaction between Ketoconazole and Topotecan?
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 P-glycoprotein inhibitors with oral topotecan. If combined with the intravenous form, monitor blood counts closely.
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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