Ergotamine 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
Ergotamine
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 ergot derivatives exposure and an increased risk of ergotism (nausea, vomiting, vasospastic ischemia)
Interaction Deep Dive
Ergot derivative use is contraindicated with ketoconazole (a strong CYP3A4 inhibitor), due to the increased risk for ergotism, i.e., a risk for vasospasm potentially leading to cerebral ischemia and/or ischemia of the extremities. Under no circumstances ergot alkaloids be coadministered with ketoconazole, and up to one week after discontinuation of treatment with ketoconazole1. There have been a few reports of serious adverse events associated with the coadministration of dihydroergotamine and potent CYP3A4 inhibitors, resulting in vasospasm that led to cerebral ischemia and/or ischemia of the extremities 2.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism by ketoconazole
Literature reports
1 report — tap to read
a) There have been a few reports of serious adverse events associated with the coadministration of dihydroergotamine and potent CYP3A4 inhibitors, resulting in vasospasm that led to cerebral ischemia and/or ischemia of the extremities 2.
Common questions
Can I take Ergotamine and Ketoconazole Topical together?
Increased ergot derivatives exposure and an increased risk of ergotism (nausea, vomiting, vasospastic ischemia) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ergotamine 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 "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Ergotamine 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)
- Product Information: Ketoconazole oral tablet, ketoconazole oral tablet. Taro Pharmaceuticals U.S.A. Inc. (per DailyMed), Hawthorne, NY, 2024. DailyMed
- Product Information: Migranal(R) nasal spray, dihydroergotamine mesylate nasal spray. Bausch Health US LLC (per FDA), Bridgewater, NJ, 2022. DailyMed
Keep reading about Ketoconazole Topical
Keep reading about Ergotamine
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