Sertraline 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
Sertraline
No brand names on recordLevoketoconazole
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.
Let's talk about taking sertraline (an antidepressant) together with levoketoconazole (Recorlev). Both medicines can affect your heart's electrical rhythm in a way called QT prolongation. When two drugs that do this are combined, the effect can add up and raise the risk of a dangerous irregular heartbeat.
On top of that, levoketoconazole can slow down how your body clears sertraline, so more of it may build up and cause more side effects. Because of this, the two are generally not used together. The good news is your care team can manage this. Please don't stop either medicine on your own. Instead, talk with your doctor or pharmacist so they can choose the safest plan for you.
Contraindicated combination. Two concerns overlap here:
- Additive QT prolongation: both sertraline and levoketoconazole can prolong the QT interval, increasing risk of torsades de pointes. Levoketoconazole labeling contraindicates use with known QT-prolonging drugs.
- PK interaction: levoketoconazole is a potent CYP3A4 inhibitor and sertraline is partly a CYP3A4 substrate, so exposure (AUC/Cmax) may rise, amplifying serotonergic and QT-related adverse effects.
Evidence is theoretical; onset unspecified. Management: avoid coadministration. If therapy is unavoidable, obtain baseline and frequent ECG monitoring, correct electrolytes (K+, Mg2+), and individualize dosing. Consider a non-QT-prolonging antidepressant alternative in consultation with the prescriber.
What happens
An increased risk of QT interval prolongation and torsades pointes, an increased CYP3A4 substrate exposure and an increased risk of CYP3A4 substrate-related adverse reactions
Interaction Deep Dive
In patients receiving medications recognized to prolong the QT interval, levoketoconazole must not be used. ECG monitoring should be performed frequently. Administering levoketoconazole together with CYP3A4 substrates can raise the exposure to those substrates, which may in turn heighten the risk of adverse reactions related to CYP3A4 substrates1.
Why it happens (mechanism)
Additive QT interval prolongation; inhibition of CYP3A4-substrate metabolism by levoketoconazole
How to manage this interaction
Because both drugs can affect heart rhythm and levoketoconazole can raise sertraline levels, this pairing is generally avoided. Here is what usually happens and what you can do:
- Keep taking both as prescribed until you speak with your care team. Do not stop or change doses on your own.
- Your team may choose an alternative antidepressant that does not affect the QT interval, or adjust and individualize your therapy.
- If both are truly needed, expect frequent ECG monitoring and checks of blood electrolytes.
- Tell your pharmacist or prescriber about any dizziness, fainting, or palpitations right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Sertraline and Levoketoconazole together?
Sertraline and levoketoconazole are generally not used together because both can prolong the heart's QT interval and levoketoconazole can raise sertraline levels; keep taking both as prescribed and contact your prescriber or pharmacist promptly to find the safest option. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Levoketoconazole 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 is the Sertraline and Levoketoconazole interaction managed?
Because both drugs can affect heart rhythm and levoketoconazole can raise sertraline levels, this pairing is generally avoided. Here is what usually happens and what you can do: Keep taking both as prescribed until you speak with your care team. Do not stop or change doses on your own. Your team may choose an alternative antidepressant that does not affect the QT interval, or adjust and individual… 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 Sertraline 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 Sertraline
Keep reading about Levoketoconazole
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