In Vivo 11β-Hydroxysteroid Dehydrogenase Inhibition in Posaconazole-Induced Hypertension and Hypokalemia

George R Thompson 3rd; Diana Chang; Rebecca R Wittenberg; Ian McHardy; Alison Semrad

doi:10.1128/AAC.00760-17

In Vivo 11β-Hydroxysteroid Dehydrogenase Inhibition in Posaconazole-Induced Hypertension and Hypokalemia

Antimicrob Agents Chemother. 2017 Jul 25;61(8):e00760-17. doi: 10.1128/AAC.00760-17. Print 2017 Aug.

Authors

George R Thompson 3rd^{1

2}, Diana Chang³, Rebecca R Wittenberg⁴, Ian McHardy⁵, Alison Semrad⁶

Affiliations

¹ Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA grthompson@ucdavis.edu.
² Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Davis, California, USA.
³ Department of Internal Medicine, University of California Davis Medical Center, Davis, California, USA.
⁴ Department of Pharmacy, University of California Davis Medical Center, Davis, California, USA.
⁵ Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA.
⁶ Department of Internal Medicine, Division of Endocrinology, University of California Davis Medical Center, Davis, California, USA.

Abstract

We describe a case of apparent mineralocorticoid excess (AME) secondary to posaconazole therapy and suggest the biochemical mechanism. Clinical and laboratory investigation confirmed 11β-hydroxysteroid dehydrogenase inhibition and withholding therapy led to a resolution of all clinical and laboratory abnormalities. Posaconazole was later restarted at a lower dose and prevented recurrence of this syndrome. Additional studies are necessary to determine the frequency of posaconazole-induced AME and whether other azole antifungals can be associated with this phenomenon.

Keywords: antifungal; posaconazole; side effects.

Publication types

Case Reports

MeSH terms

11-beta-Hydroxysteroid Dehydrogenases / antagonists & inhibitors*
Aged
Antifungal Agents / adverse effects*
Antifungal Agents / therapeutic use
Cortisone / blood
Humans
Hydrocortisone / blood
Hypertension / chemically induced*
Hypokalemia / chemically induced*
Lung / microbiology
Lung / pathology
Male
Mineralocorticoid Excess Syndrome, Apparent / chemically induced*
Pulmonary Aspergillosis / drug therapy
Triazoles / adverse effects*
Triazoles / therapeutic use

Substances

Antifungal Agents
Triazoles
posaconazole
11-beta-Hydroxysteroid Dehydrogenases
Cortisone
Hydrocortisone