Pazopanib and Ketoconazole Topical: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ketoconazole Topical
Pazopanib
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 PAZOPanib exposure and an increased risk of QT interval prolongation
Interaction Deep Dive
Coadministration of ketoconazole (a strong CYP3A4 inhibitor that may prolong the QT interval) with CYP3A4 substrates that are known to prolong the QT interval, such as PAZOPanib is contraindicated as it may cause increased CYP3A4 substrates exposure, increasing the risk for QT interval prolongation and result in life-threatening ventricular tachyarrhythmias such as torsade de pointes1. If concurrent therapy cannot be avoided, reduce the dose of PAZOPanib to 400 mg once daily. A 400 mg dose is predicted to maintain PAZOPanib AUC within the range expected without inhibitors. Further dose reduction may be necessary if adverse effects develop. Studies showed the AUC and Cmax of oral PAZOPanib were increased by 1.7- and 1.5-fold, respectively, when coadministered with ketoconazole. A single-dose of ophthalmic PAZOPanib administered with ketoconazole resulted in a 2-fold increase in mean AUC and a 1.5-fold increase in Cmax 2. When PAZOPanib and ketoconazole were coadministered, the mean AUC 24 hours post-dose and mean Cmax of PAZOPanib increased by 66% and 45%, respectively 3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of PAZOPanib; additive QT interval prolongation
Literature reports
1 report — tap to read
a) Coadministration of PAZOPanib and ketoconazole led to increases in PAZOPanib mean AUC 24 hours post-dose (786 to 1300 mcg x hr/mL; geometric least-square mean ratio, 1.66 (90% CI, 1.39 to 1.99)) and mean Cmax (40.7 to 59.2 mcg/mL; geometric least-square mean ratio, 1.45 (90% CI, 1.14 to 1.86)). Plasma samples were analyzed from 21 patients with advanced solid tumors who received oral PAZOPanib 400 mg once daily (at least 1 hour before or 2 hours after the morning meal) for 7 days and from 16 patients who then received PAZOPanib 400 mg plus oral ketoconazole 400 mg once daily (before the PAZOPanib dose in the morning) for 5 days. The mean AUC 24 hours post-dose and Cmax for PAZOPanib metabolites were lower or remained unchanged in the presence of ketoconazole. The Tmax of PAZOPanib changed very little, decreasing by a median of 0.45 hours (90% CI, -1.06 to 0.06 hours) with coadministration of ketoconazole; however, the Tmax of PAZOPanib metabolites increased by a median of more than 9 hours each 3.
Common questions
Can I take Pazopanib and Ketoconazole Topical together?
Increased PAZOPanib exposure and an increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.
How serious is the Pazopanib and Ketoconazole Topical 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 "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Pazopanib 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 (3)
- Product Information: Ketoconazole oral tablet, ketoconazole oral tablet. Taro Pharmaceuticals U.S.A. Inc. (per DailyMed), Hawthorne, NY, 2024. DailyMed
- Product Information: VOTRIENT(R) oral tablets, pazopanib oral tablets. GlaxoSmithKline (per FDA), Research Triangle Park, NC, 2013. DailyMed
- Tan AR, Gibbon DG, Stein MN, et al: Effects of ketoconazole and esomeprazole on the pharmacokinetics of pazopanib in patients with solid tumors. Cancer Chemother Pharmacol 2013; 71(6):1635-1643. PubMed
Keep reading about Ketoconazole Topical
Keep reading about Pazopanib
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