1/1/2024 0 Comments Ketoconazole creamKetoconazole can cause elevated plasma concentrations of certain drugs metabolized via CYP3A4 which may prolong the QT interval, sometimes resulting in life-threatening ventricular arrhythmias such as torsade de pointes use of ketoconazole with such drugs is contraindicated. If it is decided to restart oral ketoconazole, monitor the patient frequently to detect any recurring hepatic injury from the drug.Īpheresis, AV block, bradycardia, cardiomyopathy, celiac disease, females, fever, heart failure, hyperparathyroidism, hypocalcemia, hypokalemia, hypomagnesemia, hypothermia, hypothyroidism, ketoconazole coadministration with other drugs, long QT syndrome, myocardial infarction, pheochromocytoma, QT prolongation, rheumatoid arthritis, sickle cell disease, sleep deprivation, stroke, systemic lupus erythematosus (SLE), torsade de pointes, ventricular arrhythmiasĭue to its potent inhibition of the hepatic isoenzyme CYP3A4 oral ketoconazole coadministration with other drugs metabolized by CYP3A4 should be done with extreme caution, if at all. Hepatotoxicity has been reported upon rechallenge. Repeat liver tests to ensure normalization of values. If ALT values increase to a level above the upper limit of normal or 30 percent above baseline, or if the patient develops symptoms, ketoconazole treatment should be interrupted and a full set of liver tests should be obtained. During the course of treatment, monitor serum ALT weekly for the duration of treatment. Prompt recognition of liver injury is critical. If possible, coadministration with potentially hepatotoxic drugs should be avoided. Advise patients against ethanol ingestion while on treatment. At baseline, obtain laboratory tests (such as SGGT, alkaline phosphatase, ALT, AST, total bilirubin, prothrombin time (PT), International Normalized Ratio (INR), and testing for viral hepatitides). Patients should be informed of the risk and closely monitored if systemic ketoconazole therapy is to be given. Due to the risk of hepatotoxicity and other serious adverse effects, oral ketoconazole should only be used to treat serious fungal infections when no other antifungal therapies are available. Cases of hepatitis have been reported in pediatric patients. The hepatic injury has usually, but not always, been reversible upon discontinuation of treatment. Some patients had no obvious risk factors for hepatic disease. These cases were reported both by patients receiving high doses for short treatment durations and by patients receiving low doses for long durations. Serious hepatotoxicity, including cases with a fatal outcome or requiring liver transplantation, has occurred with the use of oral ketoconazole. Orally administered ketoconazole is contraindicated in patients with acute or chronic hepatic disease. Anaphylaxis can be life-threatening and requires immediate medical attention.Ethanol ingestion, hepatic disease, hepatitis, hepatotoxicity This medicine may cause a serious type of allergic reaction called anaphylaxis. The foam form of this medicine may make your skin more sensitive to sunlight. Wait at least 20 minutes after applying this medicine before you use cosmetics or sunscreen on the treated skin area.ĭo not use this medicine for a skin problem that has not been checked by your doctor This medicine is usually used for only 2 to 4 weeks. Apply a thin layer of the cream to the affected skin area as directed. The increase in membrane fluidity is also thought to produce impairment of membrane-bound enzyme systems as components become less closely packed.Ĭlean and dry the affected area. This metabolic inhibition also results in accumulation of 14α-methyl-3,6-diol, a toxic metabolite. This results in inhibition of ergosterol synthesis and increased fungal cellular permeability due to reduced amounts of ergosterol present in the fungal cell membrane. Ketoconazole interacts with 14-α-sterol demethylase, a cytochrome P-450 enzyme necessary for the conversion of lanosterol to ergosterol. Ketoconazole, similarly to other azole antifungals, is a fungistatic agent which causes growth arrest in fungal cells thereby preventing growth and spread of the fungus throughout the body. Ketoconazole is used in the treatment or prevention of fungal infections including blastomycosis, candidiasis, coccidioidomycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis. It functions by preventing the synthesis of ergosterol, the fungal equivalent of cholesterol, thereby increasing membrane fluidity and preventing growth of the fungus. Ketoconazole is an imidazole antifungal agent used in the prevention and treatment of a variety of fungal infections.
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