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This case report describes a patient who was newly initiated on tizanidine, an alpha2 adrenergic agonist used for muscle spasm and musculoskeletal pain, and bortezomib, a proteasome inhibitor used for multiple myeloma. Both medications are metabolized by cytochrome P450 isoenzyme 1A2. The medications were suspected of causing acute hepatitis based on the timing of their initiation and evidence to suggest that they can cause acute hepatitis. The Naranjo adverse drug reaction scale was scored as possible. In addition, the drugs\u2019 blood levels may have been increased by acyclovir and hydralazine, both inhibitors of cytochrome P450 isoenzyme 1A2. A dilemma for the team was how to best manage bortezomib. It is part of first line treatment for multiple myeloma when combined with lenalidomide and dexamethasone. Other proteasome inhibitors are available for multiple myeloma treatment. When starting chemotherapy, it is important to be aware of medications that cause a rise in liver enzymes, potential drug interactions, and how best to manage the clinical consequences.<\/jats:p>","DOI":"10.1177\/0897190020977763","type":"journal-article","created":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T07:40:42Z","timestamp":1608018042000},"page":"500-504","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Managing Multiple Myeloma in the Face of Drug-Induced Adverse Drug Reaction"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2393-6296","authenticated-orcid":false,"given":"John A.","family":"Dougherty","sequence":"first","affiliation":[{"name":"Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher T.","family":"Elder","sequence":"additional","affiliation":[{"name":"Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,12,15]]},"reference":[{"key":"bibr1-0897190020977763","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-012-0299-8"},{"key":"bibr2-0897190020977763","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.16-6-s104"},{"key":"bibr3-0897190020977763","unstructured":"Bortezomib for Injection, for Subcutaneous or Intravenous Use. [package insert]. Millennium Pharmaceuticals, Inc. Published 2019. Accessed April 15, 2020. www.velcade.com\/files\/pdfs\/velcade_prescribing_information.pdf"},{"key":"bibr4-0897190020977763","unstructured":"Multiple Myeloma. 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