Oral itraconazole should be avoided in patients with ventricular dysfunction because it:

• A Causes sodium retention through mineralocorticoid receptor antagonism
• B Has a negative inotropic effect that can precipitate heart failure ✓
• C Produces irreversible QT prolongation at therapeutic doses
• D Interferes with digoxin clearance causing arrhythmia

Explanation

Itraconazole carries a boxed warning for congestive heart failure because it exerts a negative inotropic effect through blockade of calcium channels in cardiac myocytes. In patients with reduced ejection fraction it can precipitate decompensation, so alternatives such as fluconazole or terbinafine are preferred. QT prolongation is characteristic of other azoles like fluconazole and voriconazole rather than a defining risk of itraconazole, and the digoxin interaction is not the basis for this specific warning.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.