CriticalDirect thrombin inhibitor×Systemic antimycotics. Imidazole derivatives
Updated · Methodology
Mechanism
Ketoconazole strongly blocks P-glycoprotein, the main transporter of dabigatran. Dabigatran plasma levels double, especially in renal impairment.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.
Management
The AEMPS label for dabigatran lists systemic ketoconazole as a contraindicated combination. The combination is not prescribed. Alternative antifungals: terbinafine (no P-glycoprotein use) for dermatophytosis, or echinocandins for systemic mycoses.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Pradaxa (dabigatran etexilate) prescribing information (2015)– ; DailyMed setid ba74e3cd-b06f-4145-b284-5fd6b84ff3c9
- AEMPS: Ficha técnica: Dabigatrán etexilato (nº registro 86841), sección 4.5 (2026)– AEMPS, CIMA, nº registro 86841, sección 4.5