Ketoconazole Topical and Ponatinib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ketoconazole Topical
Ponatinib
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 exposure of ponatinib
Interaction Deep Dive
Coadministration of ponatinib (a CYP3A substrate) with strong CYP3A inhibitors may increase the plasma levels of ponatinib and subsequently increase the risk of adverse events. When ponatinib was coadministered with ketoconazole, a strong CYP3A inhibitor, there was an increase in ponatinib AUC and Cmax by 78% and 47%, respectively. A similar interaction may be anticipated with other strong CYP3A inhibitors. If ponatinib is coadministered with a potent CYP3A inhibitor, it is recommended that the initial dose of ponatinib to be reduced to 30 mg orally once daily1.
Why it happens (mechanism)
Inhibition of CYP3A-mediated metabolism of ponatinib
Common questions
Can I take Ketoconazole Topical and Ponatinib together?
Increased exposure of ponatinib Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ketoconazole Topical and Ponatinib 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 "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Ketoconazole Topical or Ponatinib 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: ICLUSIG(R) oral tablets, ponatinib oral tablets. ARIAD Pharmaceuticals, Inc. (per FDA), Cambridge, MA, 2012. DailyMed
Keep reading about Ketoconazole Topical
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major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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