Drug interactions
Ketoconazole + Zanubrutinib
Severity: Major
Ketoconazole and Zanubrutinib: 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 zanubrutinib exposure, raising the risk of adverse effects such as neutropenia, bleeding and infection.
What this interaction means in plain words
Ketoconazole and Zanubrutinib 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; Zanubrutinib belongs to Oncology.
Why it happens
Strong CYP3A4 inhibition reduces zanubrutinib clearance.
What to do
Reduce zanubrutinib to 80 mg once daily with a strong CYP3A4 inhibitor. Monitor blood counts and for bleeding or infection, and resume the usual dose after ketoconazole is stopped.
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 Zanubrutinib
Frequently asked questions
Can I take Ketoconazole with Zanubrutinib?
MediHelp rates the interaction as major. Ketoconazole and Zanubrutinib 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 zanubrutinib exposure, raising the risk of adverse effects such as neutropenia, bleeding and infection.
How serious is the interaction between Ketoconazole and Zanubrutinib?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce zanubrutinib to 80 mg once daily with a strong CYP3A4 inhibitor. Monitor blood counts and for bleeding or infection, and resume the usual dose after ketoconazole is stopped.
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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