Ketoconazole Topical and Cinacalcet: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cinacalcet
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 cinacalcet exposure and an increased risk of cinacalcet-related adverse reactions
Interaction Deep Dive
Use caution when oral ketoconazole is coadministered with cinacalcet, as concomitant use may increase cinacalcet exposure. Upon coadministration, monitor patients closely for signs or symptoms of increased or prolonged effects or side effects of cinacalcet, and reduce dosage of cinacalcet as deemed necessary1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of cinacalcet
Literature reports
1 report — tap to read
a) Coadministration of cinacalcet and ketoconazole induced a 2.3-fold increase in cinacalcet bioavailability. Subjects treated for 7 days with ketoconazole 200 mg twice daily received a single dose of cinacalcet 90 mg on day 5. Compared with subjects receiving cinacalcet alone, co-treated subjects experienced 2.2 and 2.3-fold increases, respectively, in cinacalcet Cmax and AUC-time curve 2.
Common questions
Can I take Ketoconazole Topical and Cinacalcet together?
Increased cinacalcet exposure and an increased risk of cinacalcet-related adverse reactions Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ketoconazole Topical and Cinacalcet interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
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 Ketoconazole Topical or Cinacalcet 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)
Keep reading about Cinacalcet
Keep reading about Ketoconazole Topical
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist