Itraconazole Induced Congestive Heart Failure, A Case Study.

Area of Science:

• Mycology
• Pharmacology
• Cardiology

Background:

• Cardiovascular side effects, particularly congestive heart failure (HF), are rarely reported with itraconazole therapy.
• The US-FDA issued a black box warning in 2001 regarding itraconazole's cardiac risks.
• Patient populations who should avoid itraconazole due to cardiac risk remain unclear.

Observation:

• A middle-aged male with a history of pulmonary tuberculosis and obstructive uropathy presented with respiratory symptoms.
• Imaging revealed pulmonary fibrosis and an aspergilloma.
• The patient developed congestive HF within three days of initiating oral itraconazole (200mg twice daily).

Findings:

• The patient recovered after itraconazole discontinuation and diuretic treatment.
• The case supports a probable drug-induced HF, aligning with WHO-UMC criteria.
• This case suggests non-cardiac risk factors, such as pulmonary fibrosis or chronic kidney disease, may also warrant caution with itraconazole.

Implications:

• This case reaffirms the causal link between itraconazole and HF.
• It suggests that patients with pre-existing lung pathology or chronic kidney disease may be at increased risk for itraconazole-induced HF.
• Posaconazole may be a safer alternative, considering availability and cost, for patients with these risk factors.