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These changes are required for biosynthesis and energy production, and in addition are involved in signaling processes

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doi: 10.1056/NEJMoa1101214

Ketoconazole can cause elevated plasma concentrations of selected drugs metabolized via CYP3A4 which may prolong the QT interval, sometimes resulting in life-threatening ventricular arrhythmias such as torsade de pointes

Small human trials have not revealed significant toxicity, but they also lack rigorous design and long-term surveillance