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Ketoconazole Disease Interactions

There are 2 disease interactions with ketoconazole:


Ketoconazole (Includes Ketoconazole) ↔ Hepatotoxicity

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

The use of oral ketoconazole has been associated with occasional cases of hepatotoxicity. The injuries are typically hepatocellular in nature and reversible upon discontinuation of therapy, although fatalities have been reported rarely. Several cases of hepatitis have been reported in children. Liver function tests should be performed prior to initiation of therapy and regularly during treatment in patients receiving prolonged therapy with ketoconazole, particularly those with a current or past history of liver disease. Therapy should be withdrawn if persistent elevations or worsening of liver enzyme levels occur, or if the abnormalities are accompanied by symptoms of possible liver injury. Since ketoconazole is primarily metabolized by the liver, empirically reducing the dosage may also be appropriate in patients with existing liver disease.


  1. "Product Information. Nizoral (ketoconazole)." Janssen Pharmaceutica, Titusville, NJ.
  2. Stricker BH, Blok AP, Bronkhorst FB, et al "Ketoconazole-associated hepatic injury: a clinicopathological study of 55 cases." J Hepatol 3 (1986): 399-406
  3. Bercoff E, Bernuau J, Degott C, et al "Ketoconazole-induced fulminant hepatitis." Gut 26 (1985): 636-8
View all 11 references

Ketoconazole (Includes Ketoconazole) ↔ Achlorhydria

Moderate Potential Hazard, High plausibility

Applies to: Achlorhydria

Nizoral (brand of ketoconazole) tablets require acidity for proper dissolution and absorption. Therefore, the drug may not be effective in patients with achlorhydria. Taking the medication with an acidic beverage such as orange or cranberry juice may help, but an alternative antifungal agent should be considered.


  1. Lake-Bakaar G, Tom W, Lake-Bakaar D, et al "Gastropathy and ketoconazole malabsorption in the acquired immunodeficiency syndrome (AIDS)." Ann Intern Med 109 (1988): 471-3
  2. Daneshmend TK, Warnock DW, Ene MD, et al "Influence of food on the pharmacokinetics of ketoconazole." Antimicrob Agents Chemother 25 (1984): 1-3
  3. Mannisto PT, Mantyla R, Nykanen S, et al "Impairing effect of food on ketoconazole absorption." Antimicrob Agents Chemother 21 (1982): 730-3
View all 5 references

ketoconazole drug Interactions

There are 736 drug interactions with ketoconazole

ketoconazole alcohol/food Interactions

There is 1 alcohol/food interaction with ketoconazole

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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