Sinus bradycardia and chronotropic incompetence associated with single-agent itraconazole antifungal therapy: A case report

Adverse cardiac effects are a known, albeit infrequent, complication of azole antifungal drug therapy.1,2 Most often, cardiotoxicity is the result of drug–drug interactions due to azole inhibition of CYP3A4, but also of CYP2C19 and CYP2C9, leading to increased serum levels of concomitantly administered medications that require hepatic metabolism. Adverse interactions of azole antifungal drugs with digoxin or terfenadine are well known.1,3–12 Cytochrome P450 inhibition may also result in reduced activity of prodrugs that require hepatic metabolism to be converted to active metabolites.