Itraconazole: (Moderate) Ciprofloxacin should be used with warning in patients receiving itraconazole as concurrent use may enhance the chance of QT prolongation. Rare circumstances of QT prolongation and torsade de pointes (TdP) have been reported with ciprofloxacin throughout postmarketing surveillance. Itraconazole has been associated with prolongation of the QT interval.
Ranolazine: (Contraindicated) Avoid concomitant use of ketoconazole and ranolazine as a result of an elevated danger for torsade de pointes (TdP) and QT/QTc prolongation. Concomitant use may also improve the exposure of ranolazine, additional increasing the danger for hostile results. Ranolazine is a CYP3A4 substrate and ketoconazole is a strong CYP3A4 inhibitor. Coadministration with ketoconazole elevated ranolazine publicity by 220%.
Enzalutamide: (Main) Avoid enzalutamide for two weeks previous to and during remedy with ketoconazole. Concomitant use may lower exposure of ketoconazole and scale back its efficacy. If coadministration can’t be prevented, monitor for decreased efficacy of ketoconazole; a ketoconazole dose improve may be obligatory. Ketoconazole is a CYP3A substrate and enzalutamide is a strong CYP3A inducer.
Suvorexant: (Reasonable) Monitor for decreased efficacy of suvorexant if coadministration with a barbiturate is important. Suvorexant is a CYP3A4 substrate and barbiturates are robust CYP3A4 inducers. Coadministration with one other sturdy CYP3A inducer decreased suvorexant publicity by 77% to 88%. Additive CNS effects, such as sedation and psychomotor impairment, are additionally attainable. Dosage adjustments of suvorexant and of concomitant CNS depressants could also be necessary when administered collectively due to probably additive effects. The use of suvorexant with other medication dihydrocodeine to buy treat insomnia shouldn’t be beneficial. The risk of subsequent-day impairment, including impaired driving, is elevated if suvorexant is taken with different CNS depressants. Patients should be cautioned towards driving and other activities requiring complete mental alertness. (Minor) Caffeine is a central nervous system (CNS) stimulant. Patients taking medications for sleep, similar to suvorexant, eszopiclone, zaleplon, or zolpidem ought to avoid caffeine-containing medications, dietary supplements, foods, and drinks near bedtime. Patients ought to be inspired to keep away from extreme total day by day caffeine intake, as a part of proper sleep hygiene, since caffeine intake can interfere with correct sleep.
Ketoconazole: (Major) Keep away from barbiturates for 2 weeks previous to and during remedy with ketoconazole. Concomitant use could lower exposure of ketoconazole and cut back its efficacy. If coadministration cannot be avoided, monitor for decreased efficacy of ketoconazole; a ketoconazole dose improve could also be necessary. Ketoconazole is a CYP3A substrate and barbiturates are sturdy CYP3A inducers. (Moderate) Ketoconazole has been proven to inhibit the clearance of caffeine by 11 percent. The clinical significance of these interactions has not been decided.