Which antifungal agent requires monitoring of liver function due to potential hepatotoxicity?

Ketoconazole is the antifungal agent that requires monitoring of liver function due to its potential hepatotoxicity. This is primarily because ketoconazole is metabolized in the liver, and it has been associated with cases of severe liver injury, including hepatotoxicity and liver failure.

When prescribing ketoconazole, it is essential to conduct liver function tests regularly, especially during the initiation of therapy and in patients who may have pre-existing liver conditions or who are taking other medications that can affect liver function. Maintaining vigilant monitoring helps to identify any elevations in liver enzymes early, allowing for timely intervention if hepatotoxicity is suspected.

In contrast, the other antifungal agents listed, like caspofungin, nystatin, and fluconazole, generally do not require the same level of monitoring for liver function, making ketoconazole distinct in its hepatotoxic risk profile.