Cilnidipine and Ketoconazole Topical: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ketoconazole Topical
Cilnidipine
No brand names on record
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 calcium channel blockers exposure and an increased risk of calcium channel blockers-related adverse reactions
Interaction Deep Dive
Use caution with the concurrent use of calcium channel blockers and ketoconazole. Upon coadministration, monitor patients closely for signs or symptoms of increased or prolonged effects or side effects of calcium channel blockers, and reduce calcium channel blockers dose as deemed necessary. Calcium channel blockers can have a negative inotropic effect which may be additive to those of ketoconazole. The potential increase in calcium channel blockers exposure when coadministered with oral ketoconazole may increase the risk of edema and congestive heart failure1. Literature reports have documented substantial peripheral edema and/or elevated calcium antagonist exposure during concurrent use of itraconazole and felodipine, isradipine, or NIFEdipine 32.
Why it happens (mechanism)
Additive negative inotropic effect of calcium channel blockers
Literature reports
2 reports — tap to read
a) A case report of a 68-year-old woman taking NIFEdipine and atenolol for hypertension was started on itraconazole for pedal onychomycosis reported ankle edema. She apparently had never had ankle edema before. The ankle edema appeared after two to three days of itraconazole and resolved two to three days after itraconazole was discontinued. The ankle edema reappeared with each subsequent course of itraconazole except the final course. NIFEdipine trough concentrations were obtained with the last course of therapy. Relative to the itraconazole therapy trough NIFEdipine trough concentrations were obtained on 4 days prior to and three days during therapy. The mean NIFEdipine trough concentration prior to therapy was 12.7 ng/mL and 56.1 ng/mL during itraconazole therapy 2.
b) Peripheral edema and elevated serum felodipine levels were described in two patients receiving combined therapy with felodipine and itraconazole. Swelling of the lower extremities occurred in both cases within 3-7 days and resolved within 2-4 days following discontinuation of one of the agents. Re-challenge in one of the patients resulted in reoccurrence of the edema. In this patient, the felodipine AUC was found to be at least four times higher with itraconazole therapy. The authors also mention an additional patient who developed ankle swelling when itraconazole was added to isradipine therapy, however, further details were not supplied 3.
Common questions
Can I take Cilnidipine and Ketoconazole Topical together?
Increased calcium channel blockers exposure and an increased risk of calcium channel blockers-related adverse reactions Always confirm with your pharmacist or prescriber before making any change.
How serious is the Cilnidipine and Ketoconazole Topical interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
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 Cilnidipine 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 (3)
- Product Information: Ketoconazole oral tablet, ketoconazole oral tablet. Taro Pharmaceuticals U.S.A. Inc. (per DailyMed), Hawthorne, NY, 2024. DailyMed
- Tailor S, Gupta A, Walker S, et al: Peripheral edema due to nifedipine-itraconazole interaction: a case report. Arch Dermatol 1996; 132:350-352. DOI
- Neuvonen PJ & Suhonen R: Itraconazole interacts with felodipine. J Am Acad Dermatol 1995; 33:134-135. PubMed
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