Hormonal Itraconazole

Itraconazole is usually well tolerated but can be associated with nausea and epigastric distress. Dizziness and headache also have been reported. High doses may cause hypokalemia, hypertension, and edema. Itraconazole, unlike ketoconazole, is not associated with hormonal suppression. Hepatotoxicity occurs in fewer than 5% of cases and is usually manifested by reversible Uver enzyme elevations. 

A 38-year-old man with acute promyelocytic leukemia who was taking itraconazole 200 mg bd was given all-trans retinoic acid and during the third course of maintenance therapy developed acute renal insufficiency and symptomatic hypercalcemia, which was treated with high-volume crystalloid infusions and furosemide. Renal function was restored, and the serum calcium concentration returned to normal within 4 days after withdrawal of ATRA. The peak serum calcium concentration was 3.67 mmoUl. Serum parathyroid hormone was undetectable, and there were no increases in the concentrations of prostaglandins or vitamin D metabolites. Hypercalcemia recurred during a fourth course of ATRA. 

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