Ketoconazole may enhance or prolong the effect of medications metabolized with cytochrome P 450, especially from the CYP3A group. It is not possible to prescribe during the course of treatment with ketoconazole:
- midazolam and triazolam (oral forms), metabolized by isoenzyme CYP3A4 inhibitors of HMG-CoA reductase, such as simvastatin and lovastatin, ergot alkaloids (dihydroergotamine, ergometrine, ergotamine, methylergomethrin), nisoldipine, eplerenone, irinotecan, everolimus. Effects, including side effects, of these drugs are increasing.
Drugs, in the appointment of which it is necessary to monitor their concentration in the blood plasma, the severity of therapeutic effects and side effects (their dose when taken together with ketoconazole, if necessary, should be reduced):
- indirect anticoagulants;
- HIV protease inhibitors, such as indinavir, saquinavir;
- Some antineoplastic agents, such as alkaloids Carbon Pink, busulfan, docetaxel, erlotinib, imatinib;
- metabolized by isoenzyme CYP3A4 blockers of "slow" calcium channels dihydropyridine series and,perhaps, verapamil;
- some immunosuppressive agents: ciclosporin, tacrolimus, sirolimus;
- sildenafil, tolterodine;
- some inhibitors of HMG-CoA reductase, for example, atorvastatin;
- Some glucocorticosteroids, such as budesonide, fluticasone, dexamethasone and methylprednisolone;
- other drugs: digoxin, carbamazepine, buspirone, alfentanil, alprazolam, brotisolam, rifabutin, trimetrexate, ebastine, reboxetine, quetiapine, solifenacin, cilostazol, eletriptan, fentanyl, repaglinide.
Ethanol and other hepatotoxic drugs increase the risk of damage to the liver parenchyma. With the joint use of ethanol, disulfiram-like reactions may occur.
Weaken the effect of amphotericin B.
Reduces the stimulating effect of corticotropin on the adrenal glands.
Increases the risk of bleeding "breakthrough" when using single-stage oral contraceptives with low hormones.
Increases the toxicity of phenytoin.
Antatsidnye and anticholinergic drugs, blockers of H2-histamine receptors and other drugs that reduce the acidity of gastric juice, reduce the absorption of ketoconazole.