Drug interactions
Levoketoconazole + Ramelteon
Severity: Moderate
Levoketoconazole and Ramelteon: moderate 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 can raise ramelteon concentrations. Ketoconazole has been shown to increase ramelteon exposure, which may cause more sedation, dizziness or hormonal effects.
What this interaction means in plain words
Levoketoconazole and Ramelteon can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Levoketoconazole belongs to Endocrine; Ramelteon belongs to Central Nervous System.
Why it happens
Strong CYP3A4 inhibition reduces the secondary oxidative clearance of ramelteon.
What to do
Monitor for excessive sedation and next-day impairment, and consider a lower ramelteon dose or an alternative hypnotic if effects are troublesome.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Ramelteon
- Calcium / magnesium / potassium / sodium oxybates + Ramelteon Contraindicated
- Fluvoxamine + Ramelteon Contraindicated
- Ramelteon + Sodium oxybate Contraindicated
- Alfentanil + Ramelteon Moderate
- Amitriptyline + Ramelteon Moderate
- Amobarbital + Ramelteon Moderate
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 Ramelteon?
MediHelp rates the interaction as moderate. Levoketoconazole and Ramelteon can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Levoketoconazole is a strong CYP3A4 inhibitor and can raise ramelteon concentrations. Ketoconazole has been shown to increase ramelteon exposure, which may cause more sedation, dizziness or hormonal effects.
How serious is the interaction between Levoketoconazole and Ramelteon?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for excessive sedation and next-day impairment, and consider a lower ramelteon dose or an alternative hypnotic if effects are troublesome.
What other medicines interact with Ramelteon?
MediHelp also lists interactions of Ramelteon with, for example, Calcium / magnesium / potassium / sodium oxybates, Fluvoxamine, Sodium oxybate. The full list is on the Ramelteon page.
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