Domperidone 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
Domperidone
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 domperidone exposure and increased risk of QT interval prolongation
Interaction Deep Dive
Coadministration of domperidone and ketoconazole, a potent CYP3A4 inhibitor1, is contraindicated as this may result in significantly increased domperidone exposure and potentially serious cardiac effects 2,result in life-threatening ventricular tachyarrhythmias such as torsade de pointes 1. During a randomized, placebo-controlled, double-blind, crossover study in healthy volunteers, concomitant administration of domperidone and ketoconazole resulted in tripling of domperidone serum concentration levels and additive prolongation of the QT interval in men 3. In case control studies, an increased risk of sudden cardiac death was observed with the use of oral domperidone, particularly at doses greater than 30 mg/day and in patients older than 60 years of age 2.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of domperidone; additive QT interval prolongation
Literature reports
1 report — tap to read
a) During a randomized, placebo-controlled, double-blind, crossover study in healthy volunteers (14 men, 10 women; mean age 26.6 years), concomitant administration of domperidone and ketoconazole resulted in tripling of domperidone serum concentration levels and prolongation of the QT interval in men. Each subject received placebo, domperidone (10 mg 4 times daily at 4 hour intervals), ketoconazole (200 mg every 12 hours), and domperidone plus ketoconazole for periods of 7 days with a 15-day washout period. In all subjects, concomitant administration of ketoconazole with domperidone significantly increased mean domperidone AUC by 3.57 times (90% confidence interval (CI), 3.31 to 3.86) and Cmax by 2.93 times (90% CI, 2.65 to 3.25) compared with domperidone alone. Steady-state plasma concentrations of ketoconazole were not effected. In men, administration of domperidone alone, ketoconazole alone and ketoconazole plus domperidone, all resulted in significant increases in QTcF compared with placebo (4.2 milliseconds (msec), 9.24 msec, and 15.9 msec, respectively) The maximum increase on QTcF was 26.89 msec at 16 hours post dose. The maximum recorded QTcF was 459 msec. No significant change in QTcF was observed in women with either domperidone monotherapy or combination therapy 3.
Common questions
Can I take Domperidone and Ketoconazole Topical together?
Increased domperidone exposure and increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.
How serious is the Domperidone 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 Domperidone 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
- Teva Canada Limited: Dear Healthcare Professional letter for domperidone maleate. Teva Canada Limited. Toronto, Canada. 2012.
- Boyce MJ, Baisley KJ, & Warrington SJ: Pharmacokinetic interaction between domperidone and ketoconazole leads to QT prolongation in healthy volunteers: a randomized, placebo-controlled, double-blind, crossover study. Br J Clin Pharmacol 2012; 73(3):411-421. PubMed
Keep reading about Ketoconazole Topical
Keep reading about Domperidone
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