Acarbose and Levoketoconazole: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Acarbose
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.
Both of these medicines can be tough on your liver. Levoketoconazole (Recorlev) is used to treat Cushing's syndrome, and it carries a known risk of liver injury. Acarbose (Precose), which helps control blood sugar, has also been linked to liver problems in some people. Taking them together may add up and raise the chance of harm to your liver.
This concern is based on how these drugs are known to behave rather than on strong studies of the two together. The good news is that your care team can manage this. They may watch your liver with blood tests and decide the safest plan for you, so please don't change anything on your own. Just talk with your pharmacist or doctor.
Concern: Additive risk of hepatotoxicity and drug-induced liver injury when combining levoketoconazole with another agent carrying hepatotoxic potential (acarbose has documented, though uncommon, hepatic adverse effects).
- Mechanism: Unknown; presumed additive hepatocellular injury rather than a defined PK interaction. Neither is a prodrug relevant here.
- Direction: Increased cumulative hepatotoxic risk.
- Evidence: Theoretical.
- Onset: Unspecified.
- Management: The labeling advises avoiding levoketoconazole with hepatotoxic drugs. If used together, monitor LFTs (ALT, AST, bilirubin) at baseline and periodically; individualize therapy and consider alternatives.
What happens
Increased risk of serious hepatotoxicity and drug-induced liver injury
Interaction Deep Dive
Levoketoconazole should not be given together with drugs that are hepatotoxic. Using them at the same time can raise the likelihood of hepatotoxicity1.
Why it happens (mechanism)
Unknown
How to manage this interaction
What your care team may do:
- The labeling for levoketoconazole recommends avoiding it with other liver-stressing drugs, so your team may consider an alternative if appropriate.
- If both are needed, they may check your liver with blood tests before and during treatment.
- Your treatment plan can be adjusted and individualized to keep you safe.
What you should do: Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Ask your pharmacist or doctor whether this combination is right for you, and report any yellowing of the skin or eyes, dark urine, unusual tiredness, nausea, or right-upper-belly pain right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Acarbose and Levoketoconazole together?
Both drugs can stress the liver, so using them together may raise the risk of liver injury; keep taking both as prescribed and ask your prescriber whether the combination is right for you and if liver monitoring is needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose 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 Acarbose and Levoketoconazole interaction managed?
What your care team may do: The labeling for levoketoconazole recommends avoiding it with other liver-stressing drugs, so your team may consider an alternative if appropriate. If both are needed, they may check your liver with blood tests before and during treatment. Your treatment plan can be adjusted and individualized to keep you safe. What you should do: Keep taking both exactly as prescribed… 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 Acarbose 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 Acarbose
Keep reading about Levoketoconazole
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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.
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