Paliperidone and Ketoconazole Topical: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Paliperidone
Ketoconazole Topical
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
An increased risk of QT interval prolongation and torsade de pointes
Interaction Deep Dive
Both ketoconazole and paliperidone may prolong the QT interval. Avoid concomitant use of paliperidone with ketoconazole due to the potential for additive effects on QT interval prolongation and an increased risk of serious cardiac events, including torsades de pointes and/or sudden death12.
Why it happens (mechanism)
Additive QT interval prolongation
Common questions
Can I take Paliperidone and Ketoconazole Topical together?
An increased risk of QT interval prolongation and torsade de pointes Always confirm with your pharmacist or prescriber before making any change.
How serious is the Paliperidone and Ketoconazole Topical 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 strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Paliperidone or Ketoconazole Topical 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 (2)
- Product Information: ERZOFRI(R) intramuscular extended-release injectable suspension, paliperidone palmitate intramuscular extended-release injectable suspension. Luye Pharma (USA) Ltd (per FDA), Princeton, NJ, 2024.
- Product Information: INVEGA(R) oral extended-release tablets, paliperidone oral extended-release tablets. Janssen Pharmaceuticals Inc (per manufacturer), Titusville, NJ, 2018. DailyMed
Keep reading about Paliperidone
Keep reading about Ketoconazole Topical
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.
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