Drug interactions
Levoketoconazole + Sildenafil
Severity: Major
Levoketoconazole and Sildenafil: 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 that substantially increases sildenafil exposure. This may cause marked hypotension, priapism, and visual or cardiac adverse effects.
What this interaction means in plain words
Levoketoconazole and Sildenafil 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; Sildenafil belongs to Genitourinary.
Why it happens
Levoketoconazole strongly inhibits CYP3A4, the main enzyme clearing sildenafil.
What to do
Avoid for pulmonary hypertension. For erectile dysfunction use a reduced starting dose of 25 mg, no more often than every 48 hours, and monitor blood pressure.
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 Sildenafil
- Amyl nitrite + Sildenafil Contraindicated
- Atazanavir + Sildenafil Contraindicated
- Cobicistat + Sildenafil Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Sildenafil Contraindicated
- Glyceryl trinitrate pr + Sildenafil Contraindicated
- Isosorbide dinitrate + Sildenafil Contraindicated
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 Sildenafil?
MediHelp rates the interaction as major. Levoketoconazole and Sildenafil 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 that substantially increases sildenafil exposure. This may cause marked hypotension, priapism, and visual or cardiac adverse effects.
How serious is the interaction between Levoketoconazole and Sildenafil?
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 for pulmonary hypertension. For erectile dysfunction use a reduced starting dose of 25 mg, no more often than every 48 hours, and monitor blood pressure.
What other medicines interact with Sildenafil?
MediHelp also lists interactions of Sildenafil with, for example, Amyl nitrite, Atazanavir, Cobicistat. The full list is on the Sildenafil page.
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