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

BMJ Case Rep. 2021 Jun 18;14(6):e243191. doi: 10.1136/bcr-2021-243191.

Abstract

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 in all patients receiving this drug over a longer period of time. Voriconazole is probably an alternative antifungal treatment to itraconazole but also with this drug potassium levels should be monitored.

Keywords: dermatology; drugs: infectious diseases; endocrinology; hypertension; unwanted effects / adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / adverse effects
  • Drug-Related Side Effects and Adverse Reactions*
  • Humans
  • Itraconazole* / adverse effects
  • Voriconazole / adverse effects

Substances

  • Antifungal Agents
  • Itraconazole
  • Voriconazole