CASE PRESENTATION: A 65-year-old Caucasian man was admitted to the Intensive Care Unit at our facility for an extensive
ischemic stroke associated with
atrial fibrillation. Due to rapid ventricular response he was started on intravenous
amiodarone and few days later
itraconazole was also prescribed for presumed
candidemia. After receiving the first dose our patient became profoundly hypotensive but responded rapidly to fluids and
adrenaline. Then, two months later,
itraconazole was again prescribed for confirmed
fungemia. After receiving the first dose via a
central venous catheter our patient became hypotensive and subsequently arrested. He was resuscitated successfully, and as no other cause was identified the arrest was attributed to
septic shock and his antifungal treatment was changed to
caspofungin. When sensitivity test results became available, antifungal treatment was down-staged to
itraconazole and immediately after
drug administration our patient suffered another arrest and was once again resuscitated successfully. This time the arrest was related to
itraconazole, which was discontinued, and from then on our patient remained stable until his discharge to our neurology ward.
CONCLUSIONS:
Itraconazole and
amiodarone coadministration can lead to serious cardiovascular adverse events in patients who are
critically ill. Intensivists, pharmacists and medical physicians should be aware of the interaction of these two commonly used drugs.