Use Cautiously in:
CNS: dizziness, drowsiness .
EENT: photophobia .
GI: drug-induced hepatitis , nausea, vomiting , abdominal pain, constipation, diarrhea , flatulence.
GU: azoospermia , decreased male libido, menstrual irregularities , oligospermia.
Derm: rashes .
Rare cases of disulfiram-like reactions to alcohol have been reported.
Increased alfuzosin levels; avoid concomitant use.
Do not take almotriptan within 7 days of ketoconazole; do not take eletriptan within 72 h of ketoconazole.
Increased gastric pH may inhibit ketoconazole absorption; separate administration by at least 2 h.
Plasma levels may be elevated by ketoconazole; reduce aripiprazole dose by 50% during coadministration.
Benzodiazepines (eg, midazolam)
Plasma levels of benzodiazepines may be increased and prolonged.
Bosentan, buspirone, carbamazepine, cinacalet, cyclophosphamide, cyclosporine, digoxin, felodipine, gefitinib, haloperidol, loratadine, methylprednisolone, nisoldipine, opioid analgesics (eg, fentanyl), protease inhibitors (eg, indinavir), quetiapine, quinidine, quinine, risperidone, sirolimus, solifenacin, sulfonylureas, tacrolimus, taxoids (eg, docetaxel), tolterodine, tricyclic antidepressants (eg, amitriptyline), venlafaxine, zolpidem
Plasma levels may be elevated by ketoconazole, increasing the risk of adverse reactions.
Cisapride, conivaptan, eplerenone, ergot derivatives (eg, ergotamine), oral triazolam, pimozide, ranolazine
Plasma levels may be elevated by ketoconazole; coadministration with ketoconazole is contraindicated.
Antiplatelet effect of clopidogrel may be inhibited.
Increased bioavailability and decreased clearance of corticosteroid.
Didanosine, histamine H2 -receptor antagonists (eg, cimetidine), isoniazid, proton pump inhibitors (eg, omeprazole)
May decrease ketoconazole absorption.
Elevated plasma levels of dofetilide may increase the risk of life-threatening cardiac arrhythmia.
HMG-CoA reductase inhibitors (eg, atorvastatin)
Plasma levels may be increased by ketoconazole; if coadministration cannot be avoided, carefully monitor patient for rhabdomyolysis and consider using pravastatin.
Metabolism of one or both drugs may be altered. Monitor the clinical response.
Phosphodiesterase type-5 inhibitors (eg, sildenafil)
Plasma levels may be elevated by ketoconazole; reduce dose of phosphodiesterase.
Decreased serum levels of either drug; avoid concomitant use.
Decreased theophylline serum concentrations.
Vinca alkaloids (eg, vinblastine)
Plasma levels may be elevated by ketoconazole; avoid coadministration.
Increased anticoagulant effect.
Therapeutic Classification: antifungals (systemic)
Absorption: Absorption from the GI tract is pH dependent; increasing pH decreases absorption.
Distribution: Widely distributed. CNS penetration is unpredictable and minimal. Crosses the placenta; enters breast milk.
Protein Binding: 99%.
Metabolism/Excretion: Partially metabolized by the liver. Excreted in feces via biliary excretion.
Half-life: 8 hr.
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