Drug Interaction Report

Ketoconazole Topical and Rimegepant: Interaction Details

A pharmacist-reviewed analysis of the Ketoconazole Topical and Rimegepant interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Ketoconazole Topical

Extina® Foam Ketozole® Cream Kuric Nizoral AD® Shampoo Nizoral® Cream Nizoral® Shampoo Xolegel®
+

Rimegepant

Nurtec Nurtec® ODT
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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.

Of 546 documented Ketoconazole Topical interactions, 380 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
theoretical
Severity
Major

What happens

Increased exposure of rimegepant

Interaction Deep Dive

Concomitant use of rimegepant with drugs that are both strong inhibitors of CYP3A4 and P-gp efflux transport results in a significant increase in rimegepant exposure and should be avoided. At steady state, coadministration of rimegepant with itraconazole, a strong CYP3A4 inhibitor, resulted in increased exposures of rimegepant AUC by 4-fold and Cmax by about 1.5-fold1.

Why it happens (mechanism)

Inhibition of CYP3A4-mediated metabolism and P-gp efflux transport of rimegepant

Literature reports

2 reports — tap to read

a) At steady state, coadministration of a single dose of rimegepant 75 mg with itraconazole, a strong CYP3A4 inhibitor, resulted in increased exposures of rimegepant AUC by 4-fold and Cmax by about 1.5-fold 1.

b) In a dedicated drug interaction study, concomitant administration of rimegepant orally disintegrating tablet with cyclosporine (a potent P-gp and BCRP inhibitor) and with quinidine (a potent P-gp inhibitor) resulted in an increase of similar magnitude in rimegepant exposure (AUC and Cmax by 1.6- and 1.4-fold with cyclosporine, and by 1.6- and 1.7-fold with quinidine, respectively) 2.

Common questions

Can I take Ketoconazole Topical and Rimegepant together?

Increased exposure of rimegepant Always confirm with your pharmacist or prescriber before making any change.

How serious is the Ketoconazole Topical and Rimegepant 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 Rimegepant 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)

  1. Product Information: NURTEC(TM) orally disintegrating tablets, rimegepant orally disintegrating tablets. Biohaven Pharmaceuticals Inc (per FDA), New Haven, CT, 2020.
  2. Product Information: NURTEC(R) ODT orally disintegrating tablets, rimegepant orally disintegrating tablets. Biohaven Pharmaceuticals Inc (per FDA), New Haven, CT, 2021.
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Ketoconazole Topical

Keep reading about Ketoconazole Topical

All Ketoconazole Topical interactions (546) Ketoconazole Topical drug information
Also serious with: Colchicine Conivaptan Crizotinib Dabrafenib
Rimegepant

Keep reading about Rimegepant

All Rimegepant interactions (15) Rimegepant drug information
Also serious with: Nafcillin Injection Cyclosporine Injection Cyclosporine Ophthalmic Finerenone
Beyond drug–drug

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:

Rimegepant + Activated Charcoal Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato American Elder Astaxanthin + 136 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.