Azoles side effect

Q: Which of the following azoles carries the risk of a triad of hypertension, hypokalemia, and peripheral edema? (select one)

A) Fluconazole 

B) Voriconazole 

C) Posaconazole 

D) Isavuconazole

E) Itraconazole

Answer: E

Each azole antifungal comes with its unique side effect. Itraconazole may cause a triad of 

• hypertension
• hypokalemia, and
• peripheral edema

Overall this triad may culminate into congestive heart failure (CHF). It should be used with caution in cardiac patients.

Fluconazole (choice A) is known for causing alopecia.

Voriconazole (choice B) is known for causing visual changes, neurological and dermal issues, periostitis, and QT prolongation.

Posaconazole (choice C) may cause adrenal insufficiency.

Isavuconazole (choice D) can cause a severe infusion reaction.

#pharmacology

References:

1. Sharkey PK, Rinaldi MG, Dunn JF, et al. High-dose itraconazole in the treatment of severe mycoses. Antimicrob Agents Chemother 1991; 35:707.

2. Pappas PG, Kauffman CA, Perfect J, et al. Alopecia associated with fluconazole therapy. Ann Intern Med 1995; 123:354.

3. Levine MT, Chandrasekar PH. Adverse effects of voriconazole: Over a decade of use. Clin Transplant. 2016 Nov;30(11):1377-1386. doi: 10.1111/ctr.12834. Epub 2016 Oct 14. PMID: 27581783.

4. Miller A, Brooks LK, Poola-Kella S, Malek R. Posaconazole-Induced Adrenal Insufficiency in a Case of Chronic Myelomonocytic Leukemia. Case Rep Endocrinol. 2018 Jan 16;2018:2170484. doi: 10.1155/2018/2170484. PMID: 29568655; PMCID: PMC5820546.

5. Kronig I, Masouridi-Levrat S, Chalandon Y, Glampedakis E, Vernaz N, Van Delden C, Neofytos D. Clinical Considerations of Isavuconazole Administration in High-Risk Hematological Patients: A Single-Center 5-Year Experience. Mycopathologia. 2021 Dec;186(6):775-788. doi: 10.1007/s11046-021-00583-9. Epub 2021 Aug 25. PMID: 34432216; PMCID: PMC8602163.