|
Special Clinical Concerns |  |
|
Side Effects and Toxicity: |
| The imidazoles given PO result in few side effects, but nausea, vomiting, and hepatic dysfunction can develop, particularly with ketoconazole. Altered testosterone and cortisol metabolism, as well as blunted adrenal responsiveness to ACTH, have been reported, particularly with ketoconazole. Reproductive disorders related to ketoconazole administration may be seen in dogs. The other antifungal imidazoles are now used topically only. |
|  |
|
Interactions: |
| The imidazoles may be used concurrently with amphotericin B or 5-flucytosine to potentiate its antifungal activity. The absorption of the imidazoles, except for that of fluconazole, is inhibited by concurrent administration of cimetidine, ranitidine, anticholinergic agents, or gastric antacids. Rifampin decreases the serum levels of active ketoconazole because of microsomal enzyme induction. The risk of hepatotoxicity is increased if ketoconazole and griseofulvin are
administered together. Ketoconazole inhibits the metabolism of some drugs and, if administered concurrently, their concentrations may be higher than anticipated. |
| |
|
Effects on Laboratory Tests: |
| AST, ALT, plasma bilirubin, and plasma cholesterol increase. Adrenal responsiveness is altered. |
| |
