Aliskiren and Ketoconazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ketoconazole
Aliskiren
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.
What happens
Increased aliskiren exposure and an increased risk of aliskiren-related adverse reactions
Interaction Deep Dive
Use caution when aliskiren (P-gp substrate) with ketoconazole (P-gp inhibitor) are coadministered, as it may increase aliskiren exposure. Upon coadministration, monitor patients closely for signs or symptoms of increased or prolonged effects or side effects of aliskiren, and reduce dosage of aliskiren as deemed necessary1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of aliskiren
Common questions
Can I take Aliskiren and Ketoconazole together?
Increased aliskiren exposure and an increased risk of aliskiren-related adverse reactions Always confirm with your pharmacist or prescriber before making any change.
How serious is the Aliskiren and Ketoconazole 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 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 Aliskiren or Ketoconazole 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: Ketoconazole oral tablet, ketoconazole oral tablet. Taro Pharmaceuticals U.S.A. Inc. (per DailyMed), Hawthorne, NY, 2024. DailyMed
Keep reading about Ketoconazole
Keep reading about Aliskiren
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.
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