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Introduction and objective Itraconazole is an antifungal imidazole used for the treatment of aspergillosis. Evidence supporting the association between itraconazole and the onset of congestive heart failure (CHF) is limited and is based on cases reported after drug market release. Case report We report the case of a 76-year-old man with hypertension and COPD GOLD D who experienced heart failure after receiving a new line of treatment with itraconazole. The patient's symptoms resolved completely after the drug's withdrawal and initiation of treatment with diuretic therapy. Using validated algorithms, we concluded that there was a probable association between itraconazole and the onset of CHF. Conclusions The association between the administration of itraconazole and the onset of CHF is difficult to prove. Further observational studies are needed to assess this association. However, based on the available evidence, we should consider this possible adverse effect and even contraindicate this treatment in patients with a structural heart disease.

Resumen Introduccion y objetivo Itraconazol es un antifungico imidazolico para el tratamiento de la aspergilosis. La evidencia que respalda la asociacion entre itraconazol y el desarrollo de insuficiencia cardiaca congestiva (ICC) es limitada y se basa en los casos notificados poscomercializacion del farmaco. Caso clinico Presentamos el caso de un varon de 76 anos, hipertenso, con EPOC GOLD D, que presenta un inicio de insuficiencia cardiaca tras la introduccion de tratamiento con itraconazol. Tras la retirada del farmaco y tratamiento diuretico muestra resolucion completa del cuadro clinico. Tras utilizar varios algoritmos validados sobre causalidad de efectos adversos se concluyo como probable la asociacion entre itraconazol y el desarrollo de ICC en este caso. Conclusiones La asociacion entre la administracion de itraconazol y el desarrollo de ICC es una relacion causal dificil de demostrar. Son necesarios estudios observacionales dirigidos a evaluar tal asociacion. No obstante, con la evidencia disponible debemos considerar la posibilidad de dicho efecto adverso e incluso valorar la contraindicacion en pacientes con antecedentes de cardiopatia estructural.