MajorSelective serotonin reuptake inhibitors (SSRIs)×Systemic antimycotics. Imidazole derivatives
Updated · Methodology
Mechanism
Ketoconazole prolongs the QT interval and strongly inhibits CYP3A4, one of the pathways that metabolise escitalopram. The escitalopram label contraindicates concomitant use with QT-prolonging drugs, and that is the main argument for this pair; the metabolic rise in concentration only adds to it. Topical ketoconazole – shampoo, cream – has minimal systemic absorption and this pair does not apply to it.
Symptoms
Palpitations, dizziness, syncope; on ECG, a prolonged QTc. From the escitalopram side, nausea, insomnia, tremor and sweating as signs of a high concentration.
Management
The combination is avoided. For dermatophyte infection terbinafine or topical treatment serves; for systemic mycosis, a different azole or an echinocandin depending on the fungus. If there is no alternative, an ECG before starting and a few days in, with potassium and magnesium corrected beforehand and the escitalopram dose at the low end.
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
- AEMPS: Ficha técnica Escitalopram Cinfa 10 mg comprimidos recubiertos con película EFG (2024)– AEMPS, CIMA, nº registro 71430, secciones 4.3 y 4.5