From the Guidelines
Itraconazole can cause myocardial problems, particularly in patients with a history of congestive heart failure or decreased cardiac ejection fraction, due to its negative inotropic properties. This is evident from the latest guidelines on the prevention and treatment of cancer-related infections, which highlight the potential toxicities and drug-drug interactions of azoles, including itraconazole 1. The medication's negative inotropic effect can directly reduce the heart's contractile strength, leading to increased risk of cardiac complications. Furthermore, itraconazole can increase the plasma concentrations of other medications that are metabolized by the 3A4 isoenzyme, potentially causing QTc prolongation and ventricular tachyarrhythmias 1.
Key points to consider when prescribing itraconazole include:
- Its contraindication in patients with a decreased cardiac ejection fraction or a history of congestive heart failure
- The potential for QTc prolongation, particularly when combined with other drugs such as fluoroquinolones, macrolides, or ondansetron
- The need for cardiac evaluation before starting treatment in high-risk patients
- The importance of monitoring cardiac function during treatment and discontinuing the medication if signs of heart failure develop
Overall, while itraconazole can be an effective antifungal medication, its potential to cause myocardial problems must be carefully considered, particularly in patients with pre-existing cardiac conditions 1.
From the FDA Drug Label
Itraconazole has been shown to have a negative inotropic effect When itraconazole was administered intravenously to anesthetized dogs, a dose-related negative inotropic effect was documented. In a healthy volunteer study of itraconazole intravenous infusion, transient, asymptomatic decreases in left ventricular ejection fraction were observed using gated SPECT imaging; these resolved before the next infusion, 12 hours later. SPORANOX has been associated with reports of congestive heart failure. Cardiac Disease SPORANOX ® Oral Solution should not be used in patients with evidence of ventricular dysfunction unless the benefit clearly outweighs the risk. Cases of CHF, peripheral edema, and pulmonary edema have been reported in the postmarketing period among patients being treated for onychomycosis and/or systemic fungal infections.
Yes, itraconazole can cause myocardial problems, including congestive heart failure and negative inotropic effects. Patients with risk factors for congestive heart failure should be treated with caution and monitored for signs and symptoms of CHF during treatment 22.
From the Research
Itraconazole and Myocardial Problems
- Itraconazole has been associated with various cardiac-related toxicities, including new-onset hypertension, cardiomyopathy, reduced ejection fraction, and edema 3.
- A study found that itraconazole can cause a range of serious cardiac and fluid-associated adverse events, with most common symptoms being edema, heart failure, and worsening or new hypertension 3.
- Another study reported a case of frequent premature ventricular contractions (PVC) induced by itraconazole, highlighting the potential for itraconazole to cause cardiac side-effects 4.
- Congestive heart failure has also been associated with itraconazole use, with data from the US Food and Drug Administration's Adverse Event Reporting System suggesting a link between the two 5.
- Additionally, there have been reports of cardiotoxicity with itraconazole, including cases of acute systolic heart failure 6.
- While not directly related to itraconazole, a study on managing drug-induced QT prolongation highlights the importance of considering patient-related risk factors and potential drug interactions when prescribing medications that may affect the heart 7.