Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2017 Jul 25;61(8):e00760-17.
doi: 10.1128/AAC.00760-17. Print 2017 Aug.

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

George R Thompson 3rd  1   2 , Diana Chang  3 , Rebecca R Wittenberg  4 , Ian McHardy  5 , Alison Semrad  6
Affiliations
Case Reports

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

George R Thompson 3rd et al. Antimicrob Agents Chemother. .

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.

PubMed Disclaimer

Figures

FIG 1
FIG 1
Inhibition of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) by posaconazole induces an increase in the precursor hormones cortisol and 11-deoxycortisol, leading to the syndrome of apparent mineralocorticoid excess. 11β-HSD1, 11β-hydroxysteroid dehydrogenase type 1; DHEA, dehydroepiandrosterone.
See this image and copyright information in PMC

References

    1. Patterson TF, Thompson GR III, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JA, Bennett JE. 2016. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 63:e1–. doi:10.1093/cid/ciw326. - DOI - PMC - PubMed
    1. Jung DS, Tverdek FP, Kontoyiannis DP. 2014. Switching from posaconazole suspension to tablets increased serum levels in leukemia patients without clinically relevant hepatotoxicity. Antimicrob Agents Chemother 58:6993–6995. doi:10.1128/AAC.04035-14. - DOI - PMC - PubMed
    1. Pham AN, Bubalo JS, Lewis JS II. 2016. Comparison of posaconazole serum concentrations from haematological cancer patients on posaconazole tablet and oral suspension for treatment and prevention of invasive fungal infections. Mycoses. doi:10.1111/myc.12452. - DOI - PubMed
    1. Walsh TJ, Raad I, Patterson TF, Chandrasekar P, Donowitz GR, Graybill R, Greene RE, Hachem R, Hadley S, Herbrecht R, Langston A, Louie A, Ribaud P, Segal BH, Stevens DA, van Burik JA, White CS, Corcoran G, Gogate J, Krishna G, Pedicone L, Hardalo C, Perfect JR. 2007. Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial. Clin Infect Dis 44:2–12. doi:10.1086/508774. - DOI - PubMed
    1. Beck KR, Bachler M, Vuorinen A, Wagner S, Akram M, Griesser U, Temml V, Klusonova P, Yamaguchi H, Schuster D, Odermatt A. 2017. Inhibition of 11beta-hydroxysteroid dehydrogenase 2 by the fungicides itraconazole and posaconazole. Biochem Pharmacol 130:93–103. doi:10.1016/j.bcp.2017.01.010. - DOI - PMC - PubMed

Publication types

MeSH terms