Omeprazole and Levoketoconazole: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Omeprazole
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.
Here's what's going on. Levoketoconazole (Recorlev) needs an acidic stomach to dissolve and be absorbed properly. Omeprazole (Prilosec) is a proton pump inhibitor, which means it lowers stomach acid a lot. When you take them together, your stomach may not be acidic enough to absorb the levoketoconazole well, so less of it gets into your body and it may not work as well as it should.
Good news: this is manageable. Don't stop either medicine on your own. Let your pharmacist or doctor know you take both, and they can decide the best approach for you.
Mechanism: Levoketoconazole absorption is pH-dependent and requires gastric acidity for dissolution. Omeprazole, a PPI, raises gastric pH, reducing levoketoconazole dissolution and absorption.
Direction/effect: Reduced levoketoconazole exposure (lower AUC/Cmax), risking loss of efficacy in Cushing syndrome management.
- Evidence: theoretical
- Onset: unspecified
- Severity: major
Management: Avoid concomitant use. If acid suppression is required, the care team may select an alternative strategy and monitor cortisol/clinical response. Neither drug's active moiety depends on the affected process (no prodrug activation issue); this is purely reduced absorption of active levoketoconazole.
What happens
Reduced levoketoconazole exposure
Interaction Deep Dive
Levoketoconazole and proton pump inhibitors should not be taken together, since combined use can reduce the absorption of levoketoconazole1.
Why it happens (mechanism)
Impaired absorption of levoketoconazole
How to manage this interaction
What your care team may do:
- Avoid using these two together when possible, since the omeprazole can lower how much levoketoconazole your body absorbs.
- Consider a different way to manage your stomach or acid symptoms if one is needed.
- Monitor you more closely to make sure your levoketoconazole is still working (for example, checking cortisol levels and how you feel).
What you should do:
- Keep taking both exactly as prescribed for now.
- Tell your pharmacist or prescriber that you take both so they can tailor your plan.
- Do not start or stop either medicine on your own.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Omeprazole and Levoketoconazole together?
Omeprazole lowers stomach acid, which can reduce how well levoketoconazole is absorbed and possibly weaken its effect. Talk with your pharmacist or doctor, since this combination is usually best avoided. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Omeprazole and Levoketoconazole 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 is the Omeprazole and Levoketoconazole interaction managed?
What your care team may do: Avoid using these two together when possible, since the omeprazole can lower how much levoketoconazole your body absorbs. Consider a different way to manage your stomach or acid symptoms if one is needed. Monitor you more closely to make sure your levoketoconazole is still working (for example, checking cortisol levels and how you feel). What you should do: Keep taking… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Omeprazole or Levoketoconazole 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
Keep reading about Omeprazole
Keep reading about Levoketoconazole
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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist