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Drug interactions occur when the pharmacological effect of one drug is altered by another substance, either enhancing or diminishing its activity. The drug whose activity is altered is known as the object drug, and the substance causing the alteration is called the agent drug or the precipitant. The net effects of these interactions are mostly undesirable, leading to decreased effectiveness or increased adverse effects. In rare cases, interactions can be beneficial, such as the enhanced...
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A drug interaction occurs when the concurrent use of another drug, food, or an external substance alters the pharmacological activity of a drug. This interaction can modify the action of the original drug, affecting its effectiveness and safety.Drug–food interactions are significant as they impact drug absorption, metabolism, and excretion. For example, grapefruit juice is a well-known disruptor of drug metabolism. It inhibits the cytochrome P450 3A4 enzyme, crucial for the metabolism of...
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CAUTION ADVISED USING COMBINATION KETOCONAZOLE AND PD-1 INHIBITORS.

Yingying Yang1, Joel R Hecht2, Sandy Ting Liu1

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Ketoconazole (KTZ) combined with immune checkpoint inhibitors (programmed cell death protein 1 inhibitors) can cause severe liver damage in Cushing syndrome patients. Careful monitoring of liver function is crucial when using these drug combinations.

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Area of Science:

  • Oncology
  • Hepatology
  • Endocrinology

Background:

  • Immune checkpoint inhibitors (programmed cell death protein 1 inhibitors) are vital cancer therapies.
  • Cushing syndrome, characterized by hypercortisolism, is often managed with ketoconazole (KTZ).

Observation:

  • Two patients with Cushing syndrome developed life-threatening hepatic failure while on KTZ and programmed cell death protein 1 inhibitors (Nivolumab and Pembrolizumab).
  • Initial liver function was normal before adding programmed cell death protein 1 inhibitors.

Findings:

  • Drug-induced liver injury was confirmed by biopsy in both cases.
  • Hepatic function normalized after discontinuing KTZ, programmed cell death protein 1 inhibitors, and initiating methylprednisone.

Implications:

  • Combination therapy of azole antifungals (like KTZ) and programmed cell death protein 1 inhibitors requires vigilant hepatic function monitoring.
  • This case highlights a potential for severe hepatotoxicity, necessitating cautious use and close patient surveillance in clinical practice.