Ketoconazole Topical and Sonrotoclax: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ketoconazole Topical
Sonrotoclax
No brand names on record
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 sonrotoclax exposure and an increased risk of tumor lysis syndrome
Interaction Deep Dive
Concomitant use of sonrotoclax with strong CYP3A inhibitors is contraindicated as it may increase sonrotoclax exposure, which may increase the risk of sonrotoclax adverse reactions and tumor lysis syndrome at initiation and during the ramp-up phase. In drug interaction studies, sonrotoclax AUC increased 11-fold and Cmax increased 4-fold following concomitant administration of itraconazole (strong CYP3A inhibitor). And, sonrotoclax AUC increased 13-fold and Cmax increased 7-fold following concomitant administration of posaconazole (strong CYP3A inhibitor). For dose adjustments after ramp-up, reduce sonrotoclax dose to 20 mg. Resume the sonrotoclax dosage that was used prior to treatment with a strong CYP3A inhibitor at least 5 days after discontinuation of the inhibitor1.
Why it happens (mechanism)
Inhibition of CYP3A-mediated metabolism of sonrotoclax
Literature reports
1 report — tap to read
a) In drug interaction studies, sonrotoclax AUC increased 11-fold and Cmax increased 4-fold following concomitant administration of itraconazole (strong CYP3A inhibitor). And, sonrotoclax AUC increased 13-fold and Cmax increased 7-fold following concomitant administration of posaconazole (strong CYP3A inhibitor) 1.
Common questions
Can I take Ketoconazole Topical and Sonrotoclax together?
Increased sonrotoclax exposure and an increased risk of tumor lysis syndrome Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ketoconazole Topical and Sonrotoclax 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 Ketoconazole Topical or Sonrotoclax 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: BEQALZI™ oral tablets, sonrotoclax oral tablets. BeOne Medicines USA, Inc, Pennington, NJ, 2026.
Keep reading about Ketoconazole Topical
Keep reading about Sonrotoclax
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