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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".