Drug Interaction Report

Valdecoxib and Ketoconazole Topical: Interaction Details

A pharmacist-reviewed analysis of the Valdecoxib 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®
+

Valdecoxib

No brand names on record
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
Major
Potentially serious — often needs a change or close monitoring.
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 94 documented Valdecoxib interactions, 60 are rated major — 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
unspecified
Evidence
probable
Severity
Major

What happens

Increased valdecoxib plasma exposure and increased risk of valdecoxib adverse effects

Interaction Deep Dive

Valdecoxib is metabolized by CYP3A4 and CYP2C9 enzymes. Drugs such as ketoconazole, which are CYP3A4 inhibitors, decrease the metabolism of valdecoxib, causing increased plasma exposure to valdecoxib. Caution is advised when using these two agents concomitantly1 and when using ketoconazole with the parenteral prodrug parecoxib 2.

Why it happens (mechanism)

Inhibition of cytochrome P450 3A4-mediated valdecoxib metabolism

Literature reports

1 report — tap to read

a) Concomitant single dose administration of 20 mg valdecoxib with multiple doses of ketoconazole resulted in a 38% increase in plasma exposure (AUC) and Cmax to valdecoxib 21.

Common questions

Can I take Valdecoxib and Ketoconazole Topical together?

Increased valdecoxib plasma exposure and increased risk of valdecoxib adverse effects Always confirm with your pharmacist or prescriber before making any change.

How serious is the Valdecoxib 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 "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Valdecoxib 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: Bextra(R) tablets, valdecoxib tablets. G.D. Searle LLC, Division of Pfizer Inc, New York, NY, 2004.
  2. Product Information: Dynastat intravenous injection, intramuscular injection, parecoxib sodium intravenous injection, intramuscular injection. Pfizer Australia Pty Ltd (per Australian Register of Therapeutic Goods), West Ryde, Australia, 2017. 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
Valdecoxib

Keep reading about Valdecoxib

All Valdecoxib interactions (94)
Also serious with: Ketorolac Nasal Spray Ketorolac Injection Ketorolac Ophthalmic Ketorolac
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:

Valdecoxib + Activated Charcoal Asarabacca Beer Grapefruit Siberian Cocklebur St. John's Wort Wine Acacia Rigidula + 173 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.