Ketoconazole with Pioglitazone Interaction Details

Brand Names Associated with Ketoconazole

  • Ketoconazole
  • Nizoral®

Brand Names Associated with Pioglitazone

  • Actoplus Met® (as a combination product containing Metformin, Pioglitazone)
  • Actoplus Met® XR (as a combination product containing Metformin, Pioglitazone)
  • Actos®
  • Duetact® (as a combination product containing Glimepiride, Pioglitazone)
  • Oseni® (as a combination product containing Alogliptin, Pioglitazone)
  • Pioglitazone

Medical Content Editor
Last updated Dec 02, 2023

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Interaction Effect

Increased pioglitazone serum concentrations and increased risk of hypoglycemia (CNS depression, seizures, diaphoresis, tachypnea, tachycardia, hypothermia)

Interaction Summary

Concomitant use of ketoconazole and pioglitazone may increase pioglitazone serum concentrations. In healthy subjects, concurrent administration of pioglitazone 45 mg once daily with ketoconazole 200 mg twice daily for 7 days elicited increases in pioglitazone Cmax, Cmin, and AUC by 14%, 87%, and 34%, respectively. Monitor blood glucose concentrations and adjust pioglitazone dose if necessary.

Severity

Moderate

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Caution is advised if ketoconazole is used with pioglitazone. Monitor blood glucose concentrations if ketoconazole is added to or withdrawn from a treatment regimen that includes pioglitazone. Dose adjustments to pioglitazone may be necessary.

Mechanism Of Interaction

Ketoconazole inhibition of CYP3A and CYP2C isoform-mediated metabolism of pioglitazone

Ketoconazole Overview

  • 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.

See More information Regarding Ketoconazole

Pioglitazone Overview

  • Pioglitazone is used with a diet and exercise program and sometimes with other medications, to treat type 2 diabetes (condition in which the body does not use insulin normally and therefore cannot control the amount of sugar in the blood). Pioglitazone is in a class of medications called thiazolidinediones. It works by increasing the body's sensitivity to insulin, a natural substance that helps control blood sugar levels. Pioglitazone is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic ketoacidosis (a serious condition that may develop if high blood sugar is not treated).

  • Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems.Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.

See More information Regarding Pioglitazone

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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.