Drug interactions
Levoketoconazole + Pimavanserin
Severity: Major
Levoketoconazole and Pimavanserin: 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
Levoketoconazole is a strong CYP3A4 inhibitor and raises pimavanserin exposure. Levoketoconazole also prolongs the QT interval, and pimavanserin has QT-prolonging potential, so the combination adds arrhythmia risk.
What this interaction means in plain words
Levoketoconazole and Pimavanserin 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.
Levoketoconazole belongs to Endocrine; Pimavanserin belongs to Central Nervous System.
Why it happens
Strong CYP3A4 inhibition reduces pimavanserin clearance, combined with additive QT prolongation.
What to do
Reduce pimavanserin to 10 mg daily if the combination is unavoidable, per labeling for strong CYP3A4 inhibitors. Obtain a baseline ECG and monitor QTc and electrolytes.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Levoketoconazole and Pimavanserin, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 14 days on the web. No card needed.
Other interactions of Pimavanserin
- Lefamulin + Pimavanserin Contraindicated
- Pimavanserin + Pimozide Contraindicated
- Pimavanserin + Vandetanib Contraindicated
- Adagrasib + Pimavanserin Major
- Amiodarone + Pimavanserin Major
- Amisulpride + Pimavanserin Major
Other interactions of Levoketoconazole
- Alfuzosin + Levoketoconazole Contraindicated
- Alprazolam + Levoketoconazole Contraindicated
- Amiodarone + Levoketoconazole Contraindicated
- Avanafil + Levoketoconazole Contraindicated
- Cisapride + Levoketoconazole Contraindicated
- Clarithromycin + Levoketoconazole Contraindicated
Frequently asked questions
Can I take Levoketoconazole with Pimavanserin?
MediHelp rates the interaction as major. Levoketoconazole and Pimavanserin 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. Levoketoconazole is a strong CYP3A4 inhibitor and raises pimavanserin exposure. Levoketoconazole also prolongs the QT interval, and pimavanserin has QT-prolonging potential, so the combination adds arrhythmia risk.
How serious is the interaction between Levoketoconazole and Pimavanserin?
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 pimavanserin to 10 mg daily if the combination is unavoidable, per labeling for strong CYP3A4 inhibitors. Obtain a baseline ECG and monitor QTc and electrolytes.
What other medicines interact with Pimavanserin?
MediHelp also lists interactions of Pimavanserin with, for example, Lefamulin, Pimozide, Vandetanib. The full list is on the Pimavanserin page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
