Drug Interaction Report

Sunitinib and Ketoconazole Topical: Interaction Details

A pharmacist-reviewed analysis of the Sunitinib and Ketoconazole Topical interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Ketoconazole Topical

Extina® Foam Ketozole® Cream Kuric Nizoral AD® Shampoo Nizoral® Cream Nizoral® Shampoo Xolegel®
+

Sunitinib

Sutent Sutent®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Contraindicated
These should generally not be used together.
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.

Of 87 documented Sunitinib interactions, 2 are rated contraindicated — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
probable
Severity
Contraindicated

What happens

Increased exposure of SUNItinib and its active metabolite and an increased risk for QT interval prolongation

Interaction Deep Dive

Concomitant use of oral ketoconazole with a CYP3A4 substrate known to prolong the QT interval, such as SUNItinib is contraindicated, as it may increase SUNItinib exposure, increasing the risk for QT prolongation and life-threatening ventricular tachyarrhythmias, including torsades de pointes1. SUNItinib is primarily metabolized by the CYP3A4 enzyme to its active metabolite, which is also further metabolized by CYP3A4. In healthy volunteers, concomitant administration of a single dose of SUNItinib and ketoconazole, a potent CYP3A4 inhibitor, resulted in 49% and 51% increases in the combined (SUNItinib plus active metabolite) Cmax and AUC, respectively. Selection of an alternative to ketoconazole, with no or minimal enzyme inhibition potential is advised. However, if ketoconazole is used concurrently, a dose reduction for SUNItinib is recommended. Consider reducing the dose to a minimum of 37.5 mg orally daily in patients with gastrointestinal stromal tumor or advanced renal cell carcinoma, or to a minimum of 25 mg orally daily in patients with pancreatic neuroendocrine tumors 2.

Why it happens (mechanism)

Inhibition of CYP3A4-mediated metabolism of SUNItinib; additive QT interval prolongation

Literature reports

1 report — tap to read

a) In healthy volunteers, concomitant administration of a single dose of SUNItinib and ketoconazole, a potent CYP3A4 inhibitor, resulted in 49% and 51% increases in the combined (SUNItinib plus active metabolite) Cmax and AUC, respectively 2.

Common questions

Can I take Sunitinib and Ketoconazole Topical together?

Increased exposure of SUNItinib and its active metabolite and an increased risk for QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.

How serious is the Sunitinib 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 "delayed". Effects tend to build up gradually over days to weeks.

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 Sunitinib 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)

  1. Product Information: Ketoconazole oral tablet, ketoconazole oral tablet. Taro Pharmaceuticals U.S.A. Inc. (per DailyMed), Hawthorne, NY, 2024. DailyMed
  2. Product Information: SUTENT(R) oral capsules, sunitinib malate oral capsules. Pfizer Labs (per FDA), New York, NY, 2021. DailyMed
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Ketoconazole Topical

Keep reading about Ketoconazole Topical

All Ketoconazole Topical interactions (546) Ketoconazole Topical drug information
Also serious with: Colchicine Conivaptan Crizotinib Dabrafenib
Sunitinib

Keep reading about Sunitinib

All Sunitinib interactions (87) Sunitinib drug information
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Beyond drug–drug

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:

Sunitinib + Activated Charcoal Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato American Elder Astaxanthin + 130 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.