From the Research
Posaconazole and Hyperkalemia
- Posaconazole (Noxafil) is not associated with hyperkalemia, but rather with hypokalemia, as evidenced by several studies 1, 2, 3, 4.
- The mechanism of posaconazole-induced hypokalemia is thought to be due to inhibition of 11β-hydroxylase and 11β-hydroxysteroid dehydrogenase 2, leading to mineralocorticoid excess 1, 3, 4.
- Studies have shown that patients taking posaconazole are at risk of developing hypertension and hypokalemia, consistent with pseudohyperaldosteronism 2, 3, 4.
- The evidence suggests that posaconazole is associated with secondary hypertension and hypokalemia, and that development is associated with higher serum posaconazole concentrations, older age, and baseline hypertension 2.
- There is no evidence to suggest that posaconazole causes hyperkalemia, and patients taking this medication should be monitored for hypokalemia, hypertension, and symptoms of hypocortisolaemia 3.
Key Findings
- Posaconazole is associated with hypokalemia, not hyperkalemia 1, 2, 3, 4.
- Inhibition of 11β-hydroxylase and 11β-hydroxysteroid dehydrogenase 2 is the proposed mechanism for posaconazole-induced hypokalemia 1, 3, 4.
- Patients taking posaconazole should be monitored for hypertension, hypokalemia, and symptoms of hypocortisolaemia 3.