Ketoconazole-induced fulminant hepatitis necessitating liver transplantation

Knight, Timothy E.; Shikuma, Craig Y.; Knight, Judith

doi:10.1016/0190-9622(91)70214-m

Cited by 73 publications

(20 citation statements)

References 16 publications

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“…Other series did not evaluate enough patients to draw any firm conclusion. Few case reports described fatal hepatic cytolysis with ketoconazole (44)(45)(46). It is also necessary to stress that, as in another report based on three patients (31), three of our patients were treated for 60-72 months, with controlled hypersecretion and lack of adverse effects.…”

Section: Discussionmentioning

confidence: 82%

Ketoconazole revisited: a preoperative or postoperative treatment in Cushing's disease

Castinetti¹,

Morange²,

Jaquet³

et al. 2008

European Journal of Endocrinology

165

122

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Context: Although transsphenoidal surgery remains the first-line treatment in Cushing's disease (CD), recurrence is observed in about 20% of cases. Adjunctive treatments each have specific drawbacks. Despite its inhibitory effects on steroidogenesis, the antifungal drug ketoconazole was only evaluated in series with few patients and/or short-term follow-up. Objective: Analysis of long-term hormonal effects and tolerance of ketoconazole in CD. Design: A total of 38 patients were retrospectively studied with a mean follow-up of 23 months (6-72). Setting: All patients were treated at the same Department of Endocrinology in Marseille, France. Patients: The 38 patients with CD, of whom 17 had previous transsphenoidal surgery. Intervention: Ketoconazole was begun at 200-400 mg/day and titrated up to 1200 mg/day until biochemical remission. Main outcome measures: Patients were considered controlled if 24-h urinary free cortisol was normalized. Results: Five patients stopped ketoconazole during the first week because of clinical or biological intolerance. On an intention to treat basis, 45% of the patients were controlled as were 51% of those treated long term. Initial hormonal levels were not statistically different between patients controlled or uncontrolled. Ketoconazole was similarly efficacious as a primary or postoperative treatment. Among 15 patients without visible adenoma at initial evaluation, subsequent follow-up allowed identification of the lesion in five cases. No adrenal insufficiency was observed. Adverse effects were rare in patients treated long term. Conclusions: Ketoconazole is a safe and efficacious treatment in CD, particularly in patients for whom surgery is contraindicated, or delayed because of the absence of image of adenoma on magnetic resonance imaging.European Journal of Endocrinology 158 91-99

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Section: Discussionmentioning

confidence: 82%

Ketoconazole revisited: a preoperative or postoperative treatment in Cushing's disease

Castinetti¹,

Morange²,

Jaquet³

et al. 2008

European Journal of Endocrinology

165

122

View full text Add to dashboard Cite

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“…Ketoconazole is very lipophilic, which accumulates in fatty tissues leading to important side effects when administered orally. The undesired effects include severe toxic hepatitis, acquired cutaneous adherence (Svedhem, 1984;Knight et al, 1991;Polsen et al, 1995), vomiting, loss of appetite, rash, pruritus, menstrual irregularities, gynecomastia and decreased libido. This drug is not recommended during pregnancy or lactation (Flores, 2004).…”

Section: Introductionmentioning

confidence: 98%

Antifungal activity of the aqueous extract of Ilex paraguariensis against Malassezia furfur

Filip

Davicino

Anesini

2009

Phytotherapy Research

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Malassezia furfur is a lipodependent, dimorphic and saprophyte fungus which causes pityriasis versicolor, dandruff and seborrheic dermatitis in humans. The drugs available to treat this fungal infection are few. These drugs are highly toxic and are costly when used in prolonged treatments. For these reasons, it is necessary to find new compounds to treat these infections. Ilex paraguariensis St Hilaire is a plant that grows in Argentina, Brazil and Paraguay. The aim of this study was to evaluate the effect of the aqueous extract of Ilex paraguariensis on the growth of M. furfur. High performance liquid chromatography (HPLC) was employed to identify and isolate compounds of I. paraguariensis and the agar-well diffusion method was used to assess the antifungal activity of the extract. The fungicidal/fungistatic effect was evaluated by the modified Thompson assay. The results demonstrated that the aqueous extract of Ilex paraguariensis (1000 mg/ml) possesses inhibitory activity against M. furfur. This antimalassezial activity was equivalent to 2.7 microg/ml of ketoconazole. Therefore, the topical use of Ilex paraguariensis extract as alternative antifungal agent can be suggested.

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“…The most troubling side effect of ketoconazole is an idiosyncratic form of drug-induced hepatitis. There are at least seven reported cases of fulminant liver failure that resulted in fatality and a case of liver transplantation in an Asian woman who took ketoconazole for 58 days [9]. The risk of hepatitis has been assessed as 1 per 15,000 [10], 1 per 10,000 [11], and 1 per 2000 patients [12].…”

Section: Ketoconazolementioning

confidence: 99%

The systemic treatment of onychomycosis

Wenig

2004

Clinics in Podiatric Medicine and Surgery

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Ketoconazole-induced fulminant hepatitis necessitating liver transplantation

Cited by 73 publications

References 16 publications

Ketoconazole revisited: a preoperative or postoperative treatment in Cushing's disease

Ketoconazole revisited: a preoperative or postoperative treatment in Cushing's disease

Antifungal activity of the aqueous extract of Ilex paraguariensis against Malassezia furfur

The systemic treatment of onychomycosis

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