Lost Rate Control and Tachycardia-Induced Cardiomyopathy as a Result of an Interaction Between Enzalutamide and Diltiazem
Bibliographic record
Abstract
BACKGROUND: There is a theoretical drug interaction between enzalutamide, a potent cytochrome P 3A4 (CYP 3A4) inducer, and diltiazem, a CYP3A4 substrate. Resources recommend avoiding the combination. CASE SUMMARY: The patient was taking diltiazem for rate control of permanent atrial fibrillation. After initiating enzalutamide for prostate cancer, he became persistently tachycardic, developed heart failure, and was admitted. On admission, enzalutamide was held, and diltiazem was stopped. His left ventricular ejection fraction was reduced from a baseline of 52% to <15%. The patient regained rate control with metoprolol and was asymptomatic at discharge. DISCUSSION: This case describes the interaction between enzalutamide and diltiazem that resulted in a loss of rate control and subsequent heart failure. It provides a cautionary example of the complications that may arise with gaps in drug interaction management and timely monitoring and follow-up. TAKE-HOME MESSAGE: Streamlined, multidisciplinary approaches to monitoring and managing drug interactions of uncertain clinical significance, particularly in the field of cardio-oncology, are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".