{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T09:23:11Z","timestamp":1761988991730},"reference-count":46,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,8,22]],"date-time":"2016-08-22T00:00:00Z","timestamp":1471824000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Clinical Pharma"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In July 2013 the U.S. Food and Drug Administration (FDA) released a safety announcement regarding the use of ketoconazole and its adverse drug reactions. The FDA report advised against the use ketoconazole tablets as a first\u2010line treatment for any fungal infections because of the risk of potentially serious drug\u2013drug interactions and liver and adrenal gland complications. The European Medicines Agency (EMA) also proposed to limit the use of oral ketoconazole in fungal infections because of the same risk of harmful effects and interactions. In addition, the FDA also advised against the use of oral ketoconazole in drug interaction studies, in which it has been extensively used as an index inhibitor of drug metabolism. The aim of this investigation was to evaluate the risks of ketoconazole\u2010induced hepatotoxicity described by the FDA and EMA in published drug interaction studies with ketoconazole and compare these data with the toxicity reported for ketoconazole when used as antifungal treatment. In the drug interaction studies (2355 participants; healthy volunteers and patients; median treatment duration, 6 days), only 40 participants were reported to have increased liver transaminase activity (1.7%), and no deaths were reported or associated with ketoconazole. In studies investigating ketoconazole treatment, patients were treated for 276 days (median), and 5.6% of patients had elevated liver enzyme activity. Because of the short treatment period in drug interaction studies the risk of drug\u2010induced hepatic injury is considered very low. As such, we recommend that ketoconazole remain a safe CYP3A index inhibitor for use in drug interaction studies with healthy volunteers.<\/jats:p>","DOI":"10.1002\/jcph.795","type":"journal-article","created":{"date-parts":[[2016,7,13]],"date-time":"2016-07-13T09:30:24Z","timestamp":1468402224000},"page":"1203-1211","source":"Crossref","is-referenced-by-count":16,"title":["No Increased Risk of Ketoconazole Toxicity in Drug\u2013Drug Interaction Studies"],"prefix":"10.1002","volume":"56","author":[{"given":"No\u00e9mi","family":"Outeiro","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology and Pharmacoepidemiology University of Heidelberg  Heidelberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Hohmann","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and Pharmacoepidemiology University of Heidelberg  Heidelberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerd","family":"Mikus","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and Pharmacoepidemiology University of Heidelberg  Heidelberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,8,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.2015.1032939"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpdd.100"},{"issue":"3","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/S0016-5085(84)80021-9","article-title":"Hepatic injury associated with ketoconazole therapy. Analysis of 33 cases","volume":"86","author":"Lewis JH","year":"1984","journal-title":"Gastroenterology"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.290.6464.260"},{"key":"e_1_2_8_6_1","unstructured":"European Commission.Ketoconazole HRA 200 mg tablets.2014.http:\/\/ec.europa.eu\/health\/documents\/community\u2010register\/2014\/20141119130013\/anx_130013_en.pdf. Accessed June 29 2016."},{"key":"e_1_2_8_7_1","unstructured":"FDA US.FDA Drug Safety Communication: FDA limits usage of Nizoral (ketoconazole) oral tablets due to potentially fatal liver injury and risk of drug interactions and adrenal gland problems.2013.http:\/\/www.fda.gov\/downloads\/Drugs\/DrugSafety\/UCM362444.pdf. 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