Itraconazole
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Acute heart failure: case report A 44-year-old woman developed acute heart failure during treatment with itraconazole for onychomycosis. The woman was hospitalised with a 9-week history of dyspnoea, on the basis of heart failure. Treatment with prednisolone and salbutamol [albuterol] had not alleviated her symptoms. One week prior to the start of symptoms, she had started taking oral itraconazole 200mg once daily. She had stopped it 4 weeks after the start, but her dyspnoea had persisted. At the time of admission, she was in NYHA class 4. The woman was treated with candesartan cilexetil and furosemide. She was also started on a salt-restricted diet with fluid restriction. In the ensuing weeks, her dyspnoea worsened. She was readmitted and treated again with a loop diuretic and an angiotensin receptor antagonist. She was discharged on candesartan cilexetil. At last follow-up, she was not completely symptom-free. Author comment: "The Naranjo score was 4 (no other causes for the symptoms that occurred: +2 start of the symptoms after the drug was given: +2). This corresponds with an estimate of causality between the suspected side effect and itraconazole use as ’possible’." Wieringa A, et al. Acute heart failure following itraconazole use: A case report. Pharmaceutisch Weekblad 147: 195-196, No. 46, 16 Nov 2012 [Dutch; 803082623 summarised from a translation] - Netherlands
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Reactions 26 Jan 2013 No. 1436
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