Drug interactions
Levoketoconazole + Salmeterol
Severity: Major
Levoketoconazole and Salmeterol: 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 systemic salmeterol exposure. This can cause tachycardia, palpitations, tremor, hypokalemia and QT prolongation. Levoketoconazole itself prolongs the QT interval, so the cardiac risk is compounded.
What this interaction means in plain words
Levoketoconazole and Salmeterol 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; Salmeterol belongs to Respiratory.
Why it happens
Strong CYP3A4 inhibition reduces salmeterol clearance, with additive QT prolongation.
What to do
Avoid the combination and use an alternative bronchodilator that is not CYP3A4-dependent where possible. If unavoidable, monitor ECG, heart rate and potassium.
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 Salmeterol
- Ritonavir + Salmeterol Contraindicated
- Salmeterol + Saquinavir Contraindicated
- Amitriptyline + Salmeterol Major
- Arformoterol + Salmeterol Major
- Atazanavir + Salmeterol Major
- Budesonide-formoterol + Salmeterol 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 Salmeterol?
MediHelp rates the interaction as major. Levoketoconazole and Salmeterol 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 systemic salmeterol exposure. This can cause tachycardia, palpitations, tremor, hypokalemia and QT prolongation. Levoketoconazole itself prolongs the QT interval, so the cardiac risk is compounded.
How serious is the interaction between Levoketoconazole and Salmeterol?
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 the combination and use an alternative bronchodilator that is not CYP3A4-dependent where possible. If unavoidable, monitor ECG, heart rate and potassium.
What other medicines interact with Salmeterol?
MediHelp also lists interactions of Salmeterol with, for example, Ritonavir, Saquinavir, Amitriptyline. The full list is on the Salmeterol page.
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