A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her?
a. This indicates that she should begin taking oral contraceptives.
b. This is caused by a reversible effect on estradiol synthesis.
c. This is a serious side effect that warrants discontinuation of the drug.
d. This is a sign of hepatic toxicity, and the drug dose should be lowered.
B
Ketoconazole inhibits steroid synthesis in humans, and in females it reduces estradiol synthesis, causing menstrual irregularities. It is not an indication that oral contraceptive pills (OCPs) are needed. Because it is reversible, there is no indication for withdrawing the drug until treatment is complete. Menstrual irregularities are not a sign associated with hepatotoxicity.
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