Drug interactions
Levoketoconazole + Siponimod
Severity: Major
Levoketoconazole and Siponimod: 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 also inhibits CYP2C9, which can substantially raise siponimod exposure. This increases the risk of bradycardia, conduction effects and other adverse effects.
What this interaction means in plain words
Levoketoconazole and Siponimod 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; Siponimod belongs to Central Nervous System.
Why it happens
Combined inhibition of CYP3A4 and CYP2C9 reduces siponimod clearance.
What to do
Avoid the combination, as the label advises against combined CYP2C9 and CYP3A4 inhibition. If it cannot be avoided, monitor heart rate and ECG closely.
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 Siponimod
- Cladribine + Siponimod Contraindicated
- Fingolimod + Siponimod Contraindicated
- Fluconazole + Siponimod Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Siponimod Contraindicated
- Ponesimod + Siponimod Contraindicated
- Siponimod + Thioridazine 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 Siponimod?
MediHelp rates the interaction as major. Levoketoconazole and Siponimod 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 also inhibits CYP2C9, which can substantially raise siponimod exposure. This increases the risk of bradycardia, conduction effects and other adverse effects.
How serious is the interaction between Levoketoconazole and Siponimod?
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, as the label advises against combined CYP2C9 and CYP3A4 inhibition. If it cannot be avoided, monitor heart rate and ECG closely.
What other medicines interact with Siponimod?
MediHelp also lists interactions of Siponimod with, for example, Cladribine, Fingolimod, Fluconazole. The full list is on the Siponimod page.
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