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Translation of a-t 2019; 50: 78-9
 

SIDE EFFECTS

Itraconazole and hypertension

A 62-year-old woman takes the beta blocker bisoprolol (CONCOR, generics) because of hypertensive blood pressure. The patient remains normotensive in the subsequent three years on this long-term medication until her blood pressure rises to 220/110 mmHg while taking itraconazole (e.g. ITRAISDIN) for a week due to a fungal nail infection. Her blood pressure falls after the antimycotic is discontinued, but again rises to hypertensive levels two months later when the antimycotic is reintroduced (NETZWERK report 17.701). There are descriptions in the literature of hypertension and hypokalemia together with low renin and aldosterone levels during treatment with the azole antimycotics itraconazole and posaconazole (NOXAFIL). It is suspected that the two active substances influence enzymes that are significant in the formation of aldosterone, cortisol and cortisone in the adrenal glands, and that higher doses could increase the risk of hypertension (1,2). The Summary of Product Characteristics (SPC) for the original itraconazole SEMPERA lists hypertension and hypokalemia as adverse effects, that have been observed in clinical studies with the oral solution and the solution for infusion, but no frequency data is given (3). However, increased blood pressure under the antimycotic does not appear to be a rare side effect: In clinical studies, 2% of patients with onychomycosis of the toenail prematurely discontinued or withdrew from the planned 12-week treatment because of hypertension (4) and 14% of children with oral thrush or systemic fungal infections developed hypertension while receiving treatment with itraconazole (3).

1HOFFMANN, W.J. et al.: Mykoses 2018; 61: 337-9
2BECK, K.R. et al.: Pharmacol. Res., published online on 15 June 2019; doi: 10.1016/j.phrs.2019.104311 (12 pages)
3Janssen-Cilag: SPC SEMPERA 100 mg, as at Feb. 2018
4Janssen: US Product Information SPORANOX, as at March 2019; http://www.a-turl.de/?k=almb

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