Which medication is contraindicated in patients with severe cardiac problems?

Itraconazole is contraindicated in patients with severe cardiac problems due to its potential to cause negative inotropic effects and fluid retention. This antifungal medication can exacerbate conditions such as heart failure, especially if there is the presence of impaired left ventricular function. The risk of cardiovascular events increases with itraconazole usage in those with pre-existing severe cardiac conditions.

In contrast, voriconazole, amphotericin B, and nystatin have different safety profiles and mechanisms of action that make them less concerning in terms of cardiac complications. Voriconazole may be associated with visual disturbances and hepatotoxicity, while amphotericin B is primarily associated with infusion-related reactions and nephrotoxicity. Nystatin is generally considered safe for systemic use due to its limited absorption in the gastrointestinal tract and minimal systemic effects.