Drug Interaction Report

Ciclesonide Nasal Spray and Ketoconazole: Interaction Details

A pharmacist-reviewed analysis of the Ciclesonide Nasal Spray and Ketoconazole 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

Ketoconazole

Extina Ketodan Kuric Nizoral Recorlev T8 Keto Flush Xolegel
+

Ciclesonide Nasal Spray

Omnaris Omnaris® Zetonna Zetonna®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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 36 documented Ciclesonide Nasal Spray interactions, 25 are rated major — 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
probable
Severity
Major

What happens

Increased des-ciclesonide (active metabolite of ciclesonide) exposure

Interaction Deep Dive

Use caution when ketoconazole is coadministered with ciclesonide. Upon coadministration, monitor patients closely for signs or symptoms of increased or prolonged effects or side effects of ciclesonide, and reduce dosage of ciclesonide as deemed necessary2. Coadministration of orally inhaled ciclesonide and oral ketoconazole, resulted in an approximately 3.6-fold increase in des-ciclesonide AUC at steady state. However, ciclesonide levels remained unchanged 1.

Why it happens (mechanism)

Inhibition of CYP3A4-mediated metabolism of des-ciclesonide (active metabolite)

Literature reports

1 report — tap to read

a) In a drug interaction study, coadministration of orally inhaled ciclesonide and oral ketoconazole, increased des-ciclesonide AUC by approximately 3.6-fold at steady state, while levels of ciclesonide remained unchanged 1.

Common questions

Can I take Ciclesonide Nasal Spray and Ketoconazole together?

Increased des-ciclesonide (active metabolite of ciclesonide) exposure Always confirm with your pharmacist or prescriber before making any change.

How serious is the Ciclesonide Nasal Spray 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 "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Ciclesonide Nasal Spray 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 (2)

  1. Product Information: OMNARIS(R) nasal spray, ciclesonide nasal spray. Covis Pharma (per FDA), King of Prussia, PA, 2019. DailyMed
  2. Product Information: Ketoconazole oral tablet, ketoconazole oral tablet. Taro Pharmaceuticals U.S.A. Inc. (per DailyMed), Hawthorne, NY, 2024. DailyMed
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Ketoconazole

Keep reading about Ketoconazole

All Ketoconazole interactions (186)
Also serious with: Dihydroergotamine Injection Finerenone Lefamulin Loperamide
Ciclesonide Nasal Spray

Keep reading about Ciclesonide Nasal Spray

All Ciclesonide Nasal Spray interactions (36) Ciclesonide Nasal Spray drug information
Also serious with: Mifepristone Desmopressin Upadacitinib Nirmatrelvir
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:

Ketoconazole + Activated Charcoal Beer Grapefruit Siberian Cocklebur St. John's Wort Wine Acacia Rigidula Adrafinil + 174 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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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.