Regularly monitor liver function tests (LFTs), including ALT, AST, and bilirubin, throughout the treatment course. Check these at baseline, then at least weekly during the initial phase and monthly thereafter, adjusting frequency based on results and patient response. Significant elevation warrants immediate dose reduction or discontinuation of ketoconazole.
Ketoconazole Dose Adjustments
Start with the lowest effective dose of ketoconazole, carefully titrating upward as needed. Prednisone can increase ketoconazole levels, necessitating lower ketoconazole doses than usually prescribed. For example, if a patient typically requires 200mg daily, you might start at 100mg or even 50mg daily when combined with prednisone and closely observe for efficacy and side effects.
Prednisone Monitoring and Tapering
Monitor for signs of Cushing’s syndrome, including weight gain, moon face, and hypertension. Closely follow prednisone tapering schedules to minimize adrenal suppression. Gradual reduction, often over several weeks or months, depending on the initial prednisone dose and duration of therapy is preferred.
Patient Education
Educate patients about potential side effects of both medications and the importance of reporting any changes in their health promptly to their physician. This includes symptoms of liver damage (jaundice, dark urine, fatigue), increased blood pressure, and fluid retention. Encourage open communication about their experience with the medication regimen.
Drug Interactions
Be aware that ketoconazole interacts with many medications. Regularly review the patient’s medication list to assess for potential interactions that could impact efficacy or safety. This includes reviewing all over-the-counter medications and herbal supplements.
