Itraconazole
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Various cardiac and fluid-related toxicities: 31 case reports In a retrospective, single-center, descriptive, large case series between 1 January 1999 and 21 May 2019 (at Mayo Clinic Rochester; USA), 31 patients (14 women and 17 men) aged 21–84 years were described, who developed right heart failure, oedema, hypertension, pleural effusions, pulmonary oedema, shortness of breath, heart failure with preserved ejection fraction (HFpEF), Hypokalaemia, metabolic acidosis, heart failure with reduced ejection fraction (HFrEF), pericardial effusion, nocturia or cardiac arrest following treatment with itraconazole. The patients had a history of pulmonary Histoplasmosis (n=8), disseminated Histoplasmosis (n=6), disseminated Blastomyces (n=4), pulmonary Blastomyces (n=2), pulmonary Aspergillus (n=2), pulmonary (NOS) (n=2), penosynovitis (NOS) (n=1), prophylaxis (n=1), pulmonary Crytococcus (n=1), disseminated Coccidioides (n=2), tenosynovitis Histoplasmosis (n=1) or pulmonary Coccidioides (n=1). The patients started receiving oral itraconazole 100-400mg once or twice daily, capsule formulation (n=23) or liquid formulation (n=6) [not all routes, formulations and dosages stated]. Within 0.3-104 weeks [not all times to reactions onsets stated], the patients developed right heart failure (n=1), oedema (n=23), hypertension (n=8), pleural effusions (n=2), pulmonary oedema (n=2), shortness of breath (n=2), HFpEF (n=6), hypokalaemia (n=1), metabolic acidosis (n=1), HFrEF (n=6), pericardial effusion (n=1), nocturia (n=1) or cardiac arrest (n=1). The Naranjo adverse drug event scale score was found to be 5-9. The blood itraconazole and hydroxy-itraconazole levels were found to be 2-11.7 µg/mL [not all blood itraconazole and hydroxy-itraconazole levels stated]. Therefore, itraconazole treatment was discontinued in 23 patients while the itraconazole dose was modified in 6 patients. For the remaining 2 patients, the itraconazole treatment was continued. Consequently, the adverse reactions resolved in 17 patients; improved in 9 patients; and did not resolve in 4 patients [not all outcomes stated]. Teaford HR, et al. The Many Faces of Itraconazole Cardiac Toxicity. Mayo Clinic Proceedings: Innovations, Quality and Outcomes 4: 588-594, No. 5, Oct 2020. Available 803518647 from: URL: http://doi.org/10.1016/j.mayocpiqo.2020.05.006
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Reactions 5 Dec 2020 No. 1833
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