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Amiloride prevents amphotericin B related hypokalaemia in neutropenic patients
S R Smith1, M J Galloway, J T Reilly
1University Department of Haematology, Royal Liverpool Hospital.
Abstract:
Twenty neutropenic patients with various haematological disorders were randomised prospectively to receive either intravenous amphotericin B alone or amphotericin B and oral amiloride 5 mg twice a day for treatment of confirmed or suspected fungal infection. Patients receiving amiloride had a significantly higher plasma potassium (p less than 0.01), a significantly lower urinary potassium loss (p less than 0.01), and required significantly less potassium chloride supplementation to maintain their plasma potassium within the normal range (p less than 0.001). Amiloride was well tolerated, had no clinically important side effects, and provided effective control of plasma potassium in patients treated with amphotericin B.
Insights
Adding oral amiloride to amphotericin B treatment significantly improved potassium levels in neutropenic patients. This combination therapy effectively managed plasma potassium, reducing the need for supplementation and showing good tolerability.
Area of Science:
- Nephrology
- Hematology
- Infectious Diseases
Background:
- Neutropenic patients with hematological disorders are susceptible to fungal infections.
- Amphotericin B is a common antifungal treatment but can cause hypokalemia (low potassium).
- Managing electrolyte imbalances is crucial during antifungal therapy.
Purpose of the Study:
- To evaluate the efficacy of adding oral amiloride to amphotericin B for fungal infection treatment.
- To assess the impact of amiloride on potassium levels and supplementation requirements in patients receiving amphotericin B.
Main Methods:
- Prospective randomized trial involving 20 neutropenic patients.
- Patients received either intravenous amphotericin B alone or with oral amiloride (5 mg twice daily).
- Plasma and urinary potassium levels were monitored; potassium chloride supplementation was recorded.
Main Results:
- Patients receiving amiloride showed significantly higher plasma potassium (p < 0.01).
- Amiloride group had significantly lower urinary potassium loss (p < 0.01).
- Significantly less potassium chloride supplementation was needed (p < 0.001) to maintain normal potassium levels.
Conclusions:
- Oral amiloride effectively controls plasma potassium in patients treated with amphotericin B.
- Amiloride is well-tolerated with no clinically significant side effects.
- This combination therapy offers a safe and effective strategy for managing fungal infections and preventing hypokalemia.