Abacavir and Levoketoconazole: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jun 30, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Abacavir
Levoketoconazole
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
You've been prescribed abacavir (for HIV) along with levoketoconazole (Recorlev, used for Cushing's syndrome). Both of these medicines can be hard on your liver, and using them together may raise the chance of liver problems. It's worth knowing that this concern is mostly theoretical, meaning it's based on the known nature of both drugs rather than lots of real-world reports.
The good news is your care team can watch for this. They may check your liver with blood tests and look for warning signs like yellowing skin or eyes, dark urine, belly pain, or unusual tiredness. Don't stop either medicine on your own, just talk with your doctor or pharmacist about the plan.
Effect: Additive risk of hepatotoxicity and drug-induced liver injury when abacavir is combined with levoketoconazole.
- Mechanism: Unknown; presumed additive hepatic insult. Both agents carry independent hepatotoxic potential. Neither is a prodrug relevant to this direction of effect.
- Direction/magnitude: Increased cumulative liver injury risk; magnitude not quantified.
- Evidence: Theoretical.
- Onset: Unspecified.
- Management: Manufacturer labeling advises avoiding levoketoconazole with hepatotoxic drugs. If co-administration is judged necessary, obtain baseline and serial LFTs (ALT, AST, bilirubin) and counsel on hepatotoxicity symptoms.
What happens
Increased risk of serious hepatotoxicity and drug-induced liver injury
Interaction Deep Dive
The pairing of levoketoconazole with drugs that are hepatotoxic should be avoided. When taken together, the likelihood of hepatotoxicity may rise1.
Why it happens (mechanism)
Unknown
How to manage this interaction
Levoketoconazole's labeling advises against combining it with liver-stressing drugs like abacavir, so your care team will decide the safest approach for you. That may mean choosing an alternative or, if both are truly needed, monitoring you more closely.
- Keep taking both medicines exactly as prescribed unless your doctor tells you otherwise.
- Expect possible liver blood tests before and during treatment.
- Report right away: yellow skin or eyes, dark urine, pale stools, right-side belly pain, nausea, or unusual fatigue.
- Ask your pharmacist or prescriber whether this combination is right for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Abacavir and Levoketoconazole together?
Combining abacavir and levoketoconazole may add to the strain on your liver, so this pairing is generally avoided; if you take both, your care team will monitor your liver closely. Report any signs of liver trouble and don't stop either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abacavir and Levoketoconazole interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Abacavir and Levoketoconazole interaction managed?
Levoketoconazole's labeling advises against combining it with liver-stressing drugs like abacavir, so your care team will decide the safest approach for you. That may mean choosing an alternative or, if both are truly needed, monitoring you more closely. Keep taking both medicines exactly as prescribed unless your doctor tells you otherwise. Expect possible liver blood tests before and during trea… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Abacavir or Levoketoconazole need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: RECORLEV(R) oral tablets, levoketoconazole oral tablets. Xeris Pharmaceuticals Inc (per FDA), Chicago, IL, 2023. DailyMed
Keep reading about Abacavir
Keep reading about Levoketoconazole
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist