Nizoral (Ketoconazole)

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Ketoconazole can increase the concentrations of astemi-zole and terfenadine by inhibition of CYP3A4. High concentrations of terfenadine can cause cardiac toxicity. Increased plasma concentrations of unmetabolized terfenadine prolong the QT interval and carry the risk of torsade de pointes and other fatal ventricular arrhythmias.

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Patients undergoing esophagectomy are at increased risk of acute lung injury, perhaps related to increased concentrations of thromboxane in the postpulmonary circulation. In 38 consecutive patients undergoing esophagectomy, perioperative ketoconazole, which inhibits thromboxane synthesis, reduced the incidence of acute lung injury. Headache, dizziness, nervousness, and somnolence have been reported.