Azoles and pseudohyperaldosteronism

Q: Which of the following azoles may cause pseudohyperaldosteronism? - select one

A) Fluconazole

B) Voriconazole

C) Isavuconazole

D) Itraconazole 

Answer: D

Itraconazole and posaconazole are two azoles known to cause pseudohyperaldosteronism with its triad of

• severe hypokalemia
• hypertension, and
• metabolic alkalosis

Itraconazole is also known to cause congestive heart failure, and all azoles are known to cause hepatotoxicity.

#pharmacology

#endocrinology

References:

1. Kuriakose K, Nesbitt WJ, Greene M, Harris B. Posaconazole-Induced Pseudohyperaldosteronism. Antimicrob Agents Chemother 2018; 62.

2. Brandi SL, Feltoft CL, Serup J, Eldrup E. 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. PMID: 34144953; PMCID: PMC8215247.

3. Katharina R. Beck, Lucija Telisman, Chris J. van Koppen, George R. Thompson III, Alex Odermatt - Molecular mechanisms of posaconazole- and itraconazole-induced pseudohyperaldosteronism and assessment of other systemically used azole antifungals - The Journal of Steroid Biochemistry and Molecular Biology, Volume 199, May 2020, 105605. Link: https://www.sciencedirect.com/science/article/abs/pii/S0960076019306958