Levoketoconazole and Cyclosporine Ophthalmic: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine Ophthalmic
Levoketoconazole
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 cycloSPORINE exposure, an increased risk of hepatotoxicity and a drug-induced liver injury
Interaction Deep Dive
Coadministration of levoketoconazole and cycloSPORINE (a sensitive CYP3A4/P-gp substrate and a hepatotoxic agent) is contraindicated. Concurrent use of levoketoconazole (a CYP3A4 inhibitor and a P-gp inhibitor) with a hepatotoxic sensitive CYP3A4/P-gp substrate may increase exposure of the substrate resulting in increased risk of adverse reactions and an increased risk of hepatotoxicity1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of cycloSPORINE by levoketoconazole
Literature reports
1 report — tap to read
a) Coadministration of levoketoconazole 400 mg once daily with felodipine (a sensitive CYP3A4 substrate) increased felodipine AUC and Cmax by 1007% and 937%, respectively, compared with administration of felodipine alone (N=14) 1.
Common questions
Can I take Levoketoconazole and Cyclosporine Ophthalmic together?
Increased cycloSPORINE exposure, an increased risk of hepatotoxicity and a drug-induced liver injury Always confirm with your pharmacist or prescriber before making any change.
How serious is the Levoketoconazole and Cyclosporine Ophthalmic 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 Levoketoconazole or Cyclosporine Ophthalmic 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: RECORLEV(R) oral tablets, levoketoconazole oral tablets. Xeris Pharmaceuticals Inc (per FDA), Chicago, IL, 2023. DailyMed
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