Drug Interaction Report

Aripiprazole and Ketoconazole Topical: Interaction Details

A pharmacist-reviewed analysis of the Aripiprazole and Ketoconazole Topical interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Aripiprazole

Abilify Opipza
+

Ketoconazole Topical

Extina® Foam Ketozole® Cream Kuric Nizoral AD® Shampoo Nizoral® Cream Nizoral® Shampoo Xolegel®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
LinkedIn
Interaction severity
Contraindicated
These should generally not be used together.
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.

Of 86 documented Aripiprazole interactions, 3 are rated contraindicated — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
established
Severity
Contraindicated

What happens

Increased ARIPiprazole exposure and an increased risk of QT interval prolongation

Interaction Deep Dive

Coadministration of ketoconazole with ARIPiprazole is contraindicated1. Reduce the usual ARIPiprazole dose to 50% for patients on CYP3A inhibitors and to 25% for patients on dual CYP3A/CYP2D6 inhibitors 2. If CYP3A inhibitor use exceeds 14 days, reduce ARIPiprazole IM dose 400 mg to 300 mg, 300 mg to 200 mg. With dual CYP3A/CYP2D6 inhibitor use reduce ARIPiprazole IM dose 400 mg to 200 mg, 300 mg to 160 mg. If coadministered for less than 14 days, no dosage adjustment is recommended. Increase ARIPiprazole dose once the inhibitor is discontinued 3. Avoid ARIPiprazole ER 2-months injection use in patients on both strong dual CYP3A/CYP2D6 inhibitors for over 14 days. In patients only on strong CYP3A inhibitors, use 720 mg once every 2 months 4. If coadministered, reduce Aristada(R) to the next lower strength, no dose change for 441 mg monthly if tolerated 5.

Why it happens (mechanism)

Inhibition of CYP3A-mediated metabolism of ARIPiprazole; additive QT interval prolongation

Literature reports

1 report — tap to read

a) Concomitant use of ARIPiprazole with ketoconazole resulted in increased AUC and Cmax of ARIPiprazole by 1.6-fold and 1.4-fold, respectively. Concomitant use also increased the AUC and Cmax of dehydro-ARIPiprazole by 1.7-fold and 1.5-fold, respectively 34.

Common questions

Can I take Aripiprazole and Ketoconazole Topical together?

Increased ARIPiprazole exposure and an increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.

How serious is the Aripiprazole and Ketoconazole Topical 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 strong is the evidence for this interaction?

The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.

Questions for your pharmacist

  • Does my dose of Aripiprazole or Ketoconazole Topical 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 (5)

  1. Product Information: Ketoconazole oral tablet, ketoconazole oral tablet. Taro Pharmaceuticals U.S.A. Inc. (per DailyMed), Hawthorne, NY, 2024. DailyMed
  2. Product Information: ABILIFY(R) oral tablets, oral solution, intramuscular injection, aripiprazole oral tablets, oral solution, intramuscular injection. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2022. DailyMed
  3. Product Information: ABILIFY MAINTENA(R) intramuscular extended-release injection, aripiprazole intramuscular extended-release injection. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2020.
  4. Product Information: ABILIFY ASIMTUFII(R) intramuscular extended-release suspension, aripiprazole intramuscular extended-release suspension. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2023.
  5. Product Information: ARISTADA(R) intramuscular extended-release injection, aripiprazole lauroxil intramuscular extended-release injection. Alkermes Inc (per FDA), Waltham, MA, 2018.
Was this write-up helpful?
Aripiprazole

Keep reading about Aripiprazole

All Aripiprazole interactions (86)
Also serious with: Metoclopramide Nasal Spray Metoclopramide Injection Oxaliplatin Injection Abametapir
Ketoconazole Topical

Keep reading about Ketoconazole Topical

All Ketoconazole Topical interactions (546) Ketoconazole Topical drug information
Also serious with: Colchicine Conivaptan Crizotinib Dabrafenib
Beyond drug–drug

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:

Aripiprazole + 1,4-butanediol Activated Charcoal American Hellebore Arsenic Beer Cesium Ephedra Gamma-hydroxybutyrate (ghb) + 242 more

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.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

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
This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.