Ibrutinib and Levoketoconazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ibrutinib
Levoketoconazole
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 CYP3A4 substrate exposure and an increased risk of sensitive CYP3A4 substrate-related adverse reaction
Interaction Deep Dive
Coadministration of levoketoconazole and sensitive CYP3A4 substrates is contraindicated. Concomitant use of levoketoconazole (a CYP3A4 inhibitor) with a sensitive CYP3A4 substrate may increase substrate exposure and may increase the risk of sensitive CYP3A4 substrate-related adverse reactions. In a drug interaction study, coadministration of levoketoconazole 400 mg once daily with felodipine (a sensitive CYP3A4 substrate) increased felodipine AUC and Cmax by 1007% and 937%, respectively1.
Why it happens (mechanism)
Inhibition of CYP3A4-substrate metabolism by levoketoconazole
Literature reports
1 report — tap to read
a) In a drug interaction study, coadministration of levoketoconazole 400 mg once daily with felodipine (a sensitive CYP3A4 substrate) increased felodipine AUC and Cmax by 1007% and 937%, respectively, compared with administration of felodipine alone (N=14) 1.
Common questions
Can I take Ibrutinib and Levoketoconazole together?
Increased CYP3A4 substrate exposure and an increased risk of sensitive CYP3A4 substrate-related adverse reaction Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ibrutinib and Levoketoconazole 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 Ibrutinib or Levoketoconazole 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 (1)
- Product Information: RECORLEV(R) oral tablets, levoketoconazole oral tablets. Xeris Pharmaceuticals Inc (per FDA), Chicago, IL, 2023. DailyMed
Keep reading about Ibrutinib
Keep reading about Levoketoconazole
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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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