Drug Interaction Report

Elvitegravir and Ketoconazole Topical: Interaction Details

A pharmacist-reviewed analysis of the Elvitegravir 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

Ketoconazole Topical

Extina® Foam Ketozole® Cream Kuric Nizoral AD® Shampoo Nizoral® Cream Nizoral® Shampoo Xolegel®
+

Elvitegravir

No brand names on record
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 19 documented Elvitegravir interactions, 18 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
established
Severity
Major

What happens

Increased elvitegravir exposure and an increased ketoconazole exposure

Interaction Deep Dive

Caution is advised with concomitant use of elvitegravir and ketoconazole2, as it may lead to increased exposure of elvitegravir, 1 ketoconazole, or both. In a drug interaction study, administration of elvitegravir with ketoconazole resulted in increased elvitegravir Cmax and AUC ratios. If concomitant use of elvitegravir/cobicistat/emtricitabine/tenofovir with ketoconazole is necessary, limit the itraconazole dose to 200 mg/day 2.

Why it happens (mechanism)

Inhibition of CYP3A4-mediated metabolism of elvitegravir

Literature reports

1 report — tap to read

a) In a pharmacokinetic study among 18 healthy volunteers, coadministration of ritonavir-boosted elvitegravir 150 mg once daily and ketoconazole 200 mg twice daily led to increased elvitegravir exposure. The mean Cmax and AUC ratio of elvitegravir was 1.17 (90% CI, 1.04 to 1.33) and 1.48 (90% CI, 1.36 to 1.62), respectively 2.

Common questions

Can I take Elvitegravir and Ketoconazole Topical together?

Increased elvitegravir exposure and an increased ketoconazole exposure Always confirm with your pharmacist or prescriber before making any change.

How serious is the Elvitegravir 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 "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 Elvitegravir 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 (2)

  1. Product Information: Ketoconazole oral tablet, ketoconazole oral tablet. Taro Pharmaceuticals U.S.A. Inc. (per DailyMed), Hawthorne, NY, 2024. DailyMed
  2. Product Information: STRIBILD(R) oral tablets, elvitegravir cobicistat emtricitabine tenofovir disoproxil fumarate oral tablets. Gilead Sciences Inc (per FDA), Foster City, CA, 2021. DailyMed
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Ketoconazole Topical

Keep reading about Ketoconazole Topical

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

Keep reading about Elvitegravir

All Elvitegravir interactions (19)
Also serious with: Levonorgestrel Intrauterine System Orlistat Dexamethasone Ophthalmic Medroxyprogesterone Injection
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:

Elvitegravir + Activated Charcoal Calcium Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato American Elder + 131 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.