Sporanox and heart disease

A patient asked:

At the moment this talk about side effects of Sporanox does worry me,
especially as my illness is reasonably mild in relation to others. At present I feel that I am lucky in so much that I am still fit enough to play squash twice a week etc. I have ongoing sinus infections but have never been hospitalised due to ABPA. I am 45 and carry the CF gene but doctors don't think I have CF (Although apparently they say this is not as clear cut as it was once thought).

I am taking 200g Sporanox a day, Flixonase and Flixotide with volumatic for
ABPA and associated symptoms. I take Sporanox for durations between two and four months at a time. My doctor (who I trust) trusts me to read the
symptoms and lets me start and stop as when ever I want on repeat
prescription basis. I try to use Sporanox for spells of between 2 and 4
months at a time as advised, but feel these durations will increase as I get
older. I see my consultant about every 3 or 4 months for check ups, and
prior to this I have a blood test to monitor IGE and liver function.

My question is when you say "Regular blood tests" is every 3 or 4 months
regular enough? There is a history of Angina on one side of my family.
Does my treatment seem sensible, i.e. should a patient be trusted to read
their own symptoms?

I am concerned that if I am using this medication too readily now whilst my
condition is not severe, I may jeopardise it's effects later when I really
am struggling.

Hello Simon

The advice regarding use of sporanox given by the FDA (see http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01083.html ) relates to anyone being prescribed this drug who is showing signs of heart disease or has a history of the same.
The effect of the drug in such people is to weaken the heart muscle and significantly worsen the condition.
Doctors have been advised to discontinue use of sporanox immediately if the patient shows any signs of chronic heart disease - only your doctor can advise you on this.

Experiments (on animals) showed that once discontinued, the heart condition recovered rapidly.

The frequency of your blood tests is OK.

Whether or not it is best to take Sporanox now is somewhat in your hands. The main principle in treating ABPA is to prevent scarring of the lungs caused by the Aspergillus infection. If you were to stop taking the sporanox (or steroid if this is used) then the scarring process may well speed up making things worse in the long run.
I am not aware of the fungus in a particular patient rapidly becoming resistant to sporanox, though there are resistant strains, so my guess is that if the sporanox is working now it will carry on working for the forseeable future.
In the worst case scenario if your disease stops being controlled by the sporanox you will currently have to take prednisone (with all its unpleasant side-effects), but there are new treatments being developed which we hope will be useful sooner or later.
My advice is to limit the lung scarring now as much as is possible - as long as you have no toxic effect of sporanox keep taking it!