A client taking zafirlukast reports new fatigue, right upper-quadrant pain, dark urine, pruritus, and yellow sclera. Which instruction should the nurse give?
1Increase the zafirlukast dose because these findings indicate worsening airway inflammation.
2Continue the medication and discuss the symptoms at the next routine appointment.
3Take zafirlukast with a high-fat meal to reduce the hepatic adverse effects.
4Stop zafirlukast, notify the provider immediately, and obtain urgent liver-function evaluation.✓ Correct answer
Explanation
Fatigue, right upper-quadrant pain, pruritus, dark urine, and jaundice suggest zafirlukast-associated liver dysfunction. The medication should be discontinued, the provider notified immediately, and liver tests—especially ALT—measured promptly. If testing confirms hepatic dysfunction without another cause, zafirlukast should not be resumed or restarted. Increasing the dose, delaying evaluation, or changing meal timing does not address the potential injury.
Clinical reasoning Zafirlukast can rarely cause serious hepatotoxicity, including liver failure. Symptoms may precede or accompany abnormal transaminases and bilirubin.
Decision rule Stop zafirlukast and obtain immediate clinical and liver-function evaluation when symptoms of hepatic dysfunction appear; do not rechallenge after confirmed drug-related hepatic injury.
Scenario 45-year-old female on zafirlukast 20 mg PO BID × 3 months for chronic asthma. Now reports fatigue, RUQ pain, dark urine, clay-colored stools, scleral icterus.
Zafirlukast hepatotoxicity — Potentially serious liver injury that may present with fatigue, right upper-quadrant pain, nausea, pruritus, dark urine, or jaundice.
Liver-function evaluation — Prompt assessment of ALT and other hepatic markers when drug-induced liver dysfunction is suspected.
LFT monitoring — Baseline and periodic AST/ALT/bilirubin recommended with zafirlukast and zileuton.