Amitriptyline and Levoketoconazole: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Amitriptyline
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.
These two medicines are not meant to be taken together. Both amitriptyline (Elavil) and levoketoconazole (Recorlev) can affect your heart's electrical timing, something doctors call the QT interval. When the QT gets too long, it can rarely trigger a dangerous, fast heart rhythm.
Taking both at once can add these effects together, which is why the combination is listed as one to avoid. The good news is your care team knows about this. If you have been prescribed both, don't stop anything on your own. Instead, reach out to your pharmacist or doctor so they can review your medicines and find the safest plan for you.
Contraindicated combination: additive QT prolongation. Both agents independently prolong the QT interval. Levoketoconazole causes dose-related QTc prolongation, and amitriptyline (a TCA) carries a well-recognized risk of QT prolongation and torsades de pointes, particularly in overdose or with elevated plasma levels.
- Mechanism: additive pharmacodynamic QT prolongation (delayed cardiac repolarization).
- Direction: increased QTc, increased torsades risk.
- Evidence: theoretical, but severity is rated contraindicated per labeling.
- Management: avoid coadministration. If both are truly necessary, an alternative agent should be considered; the care team may monitor ECG/QTc and electrolytes (K+, Mg2+) closely.
What happens
An increased risk of QT interval prolongation and an increased risk of torsade de pointes
Interaction Deep Dive
QT interval prolongation linked to levoketoconazole occurs in a dose-related manner. It is contraindicated to give levoketoconazole together with other agents capable of producing QT prolongation that is associated with ventricular arrhythmias, torsades de pointes among them1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
This pairing is flagged as one to avoid, but your care team can manage it. Keep taking both exactly as prescribed until you speak with your prescriber or pharmacist, since stopping suddenly on your own can cause its own problems.
- Contact your pharmacist or doctor to let them know you have been prescribed both.
- Your team may choose an alternative medicine for one of them.
- If both must be used, they may monitor your heart rhythm (ECG) and check blood minerals like potassium and magnesium.
- Report fainting, dizziness, or a racing or irregular heartbeat right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Amitriptyline and Levoketoconazole together?
Amitriptyline and levoketoconazole both prolong the QT interval, and combining them is contraindicated because of the added risk of a dangerous heart rhythm. Keep taking both as prescribed for now, but contact your pharmacist or doctor promptly to review a safer option. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Levoketoconazole interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Amitriptyline and Levoketoconazole interaction managed?
This pairing is flagged as one to avoid, but your care team can manage it. Keep taking both exactly as prescribed until you speak with your prescriber or pharmacist, since stopping suddenly on your own can cause its own problems. Contact your pharmacist or doctor to let them know you have been prescribed both. Your team may choose an alternative medicine for one of them. If both must be used, they… 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Amitriptyline 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 Amitriptyline
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.
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