Ketoconazole with Domperidone Interaction Details
Brand Names Associated with Ketoconazole
- Ketoconazole
- Nizoral®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 02, 2023
Interaction Effect
Increased domperidone plasma concentrations and increased risk of QT interval prolongation
Interaction Summary
Coadministration of domperidone and ketoconazole, a potent CYP3A4 inhibitor, is contraindicated as this may result in significantly increased plasma concentrations of domperidone . During a randomized, placebo-controlled, double-blind, crossover study in healthy volunteers (14 men, 10 women; mean age 26.6 years), concomitant administration of domperidone and ketoconazole resulted in tripling of domperidone serum concentration levels and additive prolongation of the QT interval in men . In case control studies, an increased risk of sudden cardiac death was observed with the use of oral domperidone, particularly at doses greater than 30 mg/day and in patients older than 60 years of age .
Severity
Contraindicated
Onset
Unspecified
Evidence
Established
How To Manage Interaction
The concomitant use of domperidone with ketoconazole is contraindicated as this may result in significantly increased plasma concentrations of domperidone and potentially serious cardiac effects.
Mechanism Of Interaction
Inhibition of CYP3A4-mediated domperidone metabolism by ketoconazole; additive effects on QT interval
Literature Reports
A) During a randomized, placebo-controlled, double-blind, crossover study in healthy volunteers (14 men, 10 women; mean age 26.6 years), concomitant administration of domperidone and ketoconazole resulted in tripling of domperidone serum concentration levels and prolongation of the QT interval in men. Each subject received placebo, domperidone (10 mg 4 times daily at 4 hour intervals), ketoconazole (200 mg every 12 hours), and domperidone plus ketoconazole for periods of 7 days with a 15-day washout period. In all subjects, concomitant administration of ketoconazole with domperidone significantly increased mean domperidone AUC by 3.57 times (90% confidence interval (CI), 3.31 to 3.86) and Cmax by 2.93 times (90% CI, 2.65 to 3.25) compared with domperidone alone. Steady-state plasma concentrations of ketoconazole were not effected. In men, administration of domperidone alone, ketoconazole alone and ketoconazole plus domperidone, all resulted in significant increases in QTcF compared with placebo (4.2 milliseconds (msec), 9.24 msec, and 15.9 msec, respectively) The maximum increase on QTcF was 26.89 msec at 16 hours post dose. The maximum recorded QTcF was 459 msec. No significant change in QTcF was observed in women with either domperidone monotherapy or combination therapy .
Ketoconazole Overview
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Ketoconazole is used to treat fungal infections when other medications are not available or cannot be tolerated. Ketoconazole should not be used to treat fungal meningitis (infection of the membranes surrounding the brain and spinal cord caused by a fungus) or fungal nail infections. Ketoconazole is in a class of antifungals called imidazoles. It works by slowing the growth of fungi that cause infection.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.