Antifungal agent-related hepatotoxicity (liver disease) is in the news.

Recently, the FDA alerted healthcare providers about Nizoral (ketoconazole) oral tablets, and urged the limiting of the drug’s use, warning that it can cause severe liver injury. Did these cases of liver disease occur because of poor monitoring or poor patient selection? Could the physician or pharmacist have done more to prevent the combined consumption of alcohol or acetaminophen with this antifungal agent?

The FDA Mandated medication guide clearly states that liver problems (hepatotoxicity), can occur in those treated with oral ketoconazole. Were the medication guides never given out, discussed, read or believed? Will the warnings of serious liver disease that have even led to death or the need for a liver transplant convince physicians and pharmacists to screen patients better?