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Nephrogenic diabetes insipidus induced by two amphotericin B liposomal formulations

Nicole L Metzger1, Kimberly L Varney Gill

  • 1Department of Pharmacy Practice, Mercer University College of Pharmacy and Health Sciences, Atlanta, GA, USA.

Pharmacotherapy
|April 29, 2009
PubMed

Insights

High-dose liposomal amphotericin B can cause nephrogenic diabetes insipidus (DI) in immunocompromised patients. This rare but serious adverse effect requires careful monitoring and management during antifungal therapy.

Area of Science:

  • Mycology
  • Pharmacology
  • Nephrology

Background:

  • Invasive fungal infections necessitate potent antifungal agents like amphotericin B.
  • Conventional amphotericin B is associated with renal toxicity, including nephrogenic diabetes insipidus (DI).
  • Liposomal formulations aim to reduce toxicity, but rare adverse effects may still occur.

Observation:

  • A case of an 18-year-old aplastic anemia patient with invasive aspergillosis treated with high-dose liposomal amphotericin B.
  • The patient developed symptoms consistent with nephrogenic DI, which resolved upon drug discontinuation.
  • Rechallenge with lipid complex amphotericin B also triggered DI symptoms, suggesting a probable drug-induced adverse reaction.

Findings:

  • The Naranjo scale indicated a probable relationship between liposomal amphotericin B and nephrogenic DI.
  • This represents the third reported case of liposomal amphotericin B-induced nephrogenic DI.
  • Diuretics were effective in managing the patient's nephrogenic DI.

Implications:

  • Clinicians must be aware of the potential for nephrogenic DI with liposomal amphotericin B, even if uncommon.
  • Understanding all amphotericin B formulations' adverse effects is crucial for risk-benefit assessment in antifungal treatment.
  • This case highlights the importance of vigilant monitoring for renal adverse events during potent antifungal therapy.

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