President Hooverâs inactivity and belief in waiting things out left the United States in economic turmoil and in search of a new more dynamic leader. That leader was Franklin Delano Roosevelt who took over the presidency on January 20, 1933.
The mechanism of diltiazem hepatotoxicity is not known, but most cases are probably due to hypersensitivity. Diltiazem is metabolized by the cytochrome P450 system and is an inhibitor of CYP 3A4 activity, which can lead to serious drug-drug interactions and potentiation of the hepatotoxic effects of other medications.
We present a complex medical patient who suffered an exacerbation of delirium when diltiazem was added to his treatment regimen that included fentanyl. Diltiazem, an inhibitor of CYP3A4, resulted in fentanyl toxicity because fentanyl is metabolized by CYP3A4. Fentanyl contains a boxed warning for concomitant use with 3A4 inhibitors . Pharmacy programs such as Lexi-comp and MicroMedics are available to identify such drug-drug interactions, which are entirely preventable.