Ketoconazole should not be given to a patient being treated with astemizole because :
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- Ketoconazole induces the metabolism of astemizole
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- Dangerous ventricular arrhythmias can occur
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- Astemizole inhibits the metabolism of ketoconazole
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- Astemizole antagonizes the antifungal action of ketoconazole
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EXP:
Ketoconazole, erythromycin and clarithromycin are potent inhibitors of microsomal enzymes. Astemizole, terfenadine and cisapride are the drugs that can block cardiac K+ channels at high concentration. If administered along with microso-mal enzyme inhibitors, these drugs can result in torsades de pointes, a serious polymorphic ventricular tachycardia.