Pseudohyperaldosteroism during itraconazole treatment: a hitherto neglected clinically significant side effect

@article{Brandi2021PseudohyperaldosteroismDI,
  title={Pseudohyperaldosteroism during itraconazole treatment: a hitherto neglected clinically significant side effect},
  author={Sandra Louise Brandi and Claus Larsen Feltoft and J{\o}rgen Serup and Ebbe Eldrup},
  journal={BMJ Case Reports},
  year={2021},
  volume={14}
}
We describe a married couple who both presented with hypertension and hypokalaemia. Both patients were diagnosed with pseudohyperaldosteronism triggered by the widely used antifungal drug itraconazole. This effect appears to be dose-dependent, where a daily intake of 100 mg itraconazole is enough to induce pseudohyperaldosteronism. Clinicians should be aware of pseudohyperaldosteronism as a possible adverse effect of itraconazole, and we recommend monitoring potassium levels and blood pressure… 
Antifungal Therapy with Azoles Induced the Syndrome of Acquired Apparent Mineralocorticoid Excess: a Literature and Database Analysis
TLDR
The presented study supports very recent findings that posaconazole and itraconazoles, but not the other three azole antifungals investigated, are associated with AME and that the effects are dose-dependent, which allows for a dose de-escalation strategy and for substitution with fluconazole, isavuconazol, or voriconazole to resolve the adverse effects.
Itraconazole/terbinafine
  • Medicine
    Reactions Weekly
  • 2021

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