Buspirone and Ketoconazole Topical: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Buspirone
Ketoconazole Topical
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 busPIRone exposure
Interaction Deep Dive
Use caution when coadministering busPIRone, a CYP3A4 substrate, and ketoconazole, a CYP3A4 inhibitor, as this may result in increased busPIRone exposure. If a patient has been titrated to a stable dosage on busPIRone, a dose reduction of busPIRone may be necessary to avoid adverse events attributable to busPIRone or diminished anxiolytic activity. Upon coadministration, monitor patients closely for signs or symptoms of increased or prolonged effects or side effects of busPIRone, and reduce busPIRone dosage as deemed necessary1.
Why it happens (mechanism)
Inhibition of CYP3A-mediated busPIRone metabolism
Common questions
Can I take Buspirone and Ketoconazole Topical together?
Increased busPIRone exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buspirone and Ketoconazole Topical interaction?
It is rated moderate. Can be significant — usually manageable with 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Buspirone 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 anything you'd monitor while I'm on both?
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 Buspirone
Keep reading about Ketoconazole Topical
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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:
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