Ketoconazole Topical and Artemether: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Artemether
No brand names on recordKetoconazole Topical
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 artemether/lumefantrine exposure, an increased risk of QT interval prolongation, reduced ketoconazole exposure and reduced efficacy of ketoconazole
Interaction Deep Dive
Concomitant use of ketoconazole together with a CYP3A4 substrate known to prolong the QT interval, such as artemether/lumefantrine is contraindicated. Concomitant use may result in increased artemether/lumefantrine exposure, increasing the risk for QT prolongation and life-threatening ventricular tachyarrhythmias including torsades de pointes1. Concomitant use of artemether/lumefantrine and ketoconazole (CYP3A4 substrate) may also reduce ketoconazole exposure, which may reduce efficacy of ketoconazole 2.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of artemether/lumefantrine; additive QT interval prolongation; induction of CYP3A4-mediated metabolism of ketoconazole
Literature reports
1 report — tap to read
a) In a clinical study, the AUC of artemether, dihydroartemisinin (DHA, a metabolite of artemether), and lumefantrine increased 2.3-fold, 1.5-fold, and 1.6-fold, respectively, in 13 healthy subjects when artemether/lumefantrine was coadministered with ketoconazole 400 mg on day 1 followed by ketoconazole 200 mg on days 2 through 5. Ketoconazole pharmacokinetics were not evaluated. While no artemether/lumefantrine dose adjustments are recommended when administered with ketoconazole or other CYP3A4 inhibitors, caution is advised 2.
Common questions
Can I take Ketoconazole Topical and Artemether together?
Increased artemether/lumefantrine exposure, an increased risk of QT interval prolongation, reduced ketoconazole exposure and reduced efficacy of ketoconazole Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ketoconazole Topical and Artemether 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 Ketoconazole Topical or Artemether 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: COARTEM® oral tablets, artemether lumefantrine oral tablets. Novartis Pharmaceuticals Corporation (per DailyMed), East Hanover, NJ, 2025. DailyMed
Keep reading about Artemether
Keep reading about Ketoconazole Topical
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