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Pseudohyperaldosteroism during itraconazole treatment: a hitherto neglected clinically significant side effect
  1. Sandra L Brandi1,
  2. Claus L Feltoft1,
  3. Jørgen Serup2 and
  4. Ebbe Eldrup1
  1. 1Department of Endocrinology, Copenhagen University Hospital, Herlev Hospital, 2730 Herlev, Denmark
  2. 2Department of Dermatology, Bispebjerg Hospital, Kobenhavn, Denmark
  1. Correspondence to Dr Ebbe Eldrup; Ebbe.Eldrup{at}


We describe a married couple who both presented with hypertension and hypokalaemia. Both patients were diagnosed with pseudohyperaldosteronism triggered by the widely used antifungal drug itraconazole. This effect appears to be dose-dependent, where a daily intake of 100 mg itraconazole is enough to induce pseudohyperaldosteronism. Clinicians should be aware of pseudohyperaldosteronism as a possible adverse effect of itraconazole, and we recommend monitoring potassium levels and blood pressure in all patients receiving this drug over a longer period of time. Voriconazole is probably an alternative antifungal treatment to itraconazole but also with this drug potassium levels should be monitored.

  • hypertension
  • unwanted effects / adverse reactions
  • endocrinology
  • drugs: infectious diseases
  • dermatology

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  • Contributors All four authors SLB, CLF, JS and EE have contributed to the case description. EE and JS have conducted the clinical investigations and treatments of the two patients. All authors have approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.