Amiloride for the prevention of amphotericin B-induced hypokalemia and hypomagnesemia

OBJECTIVE: To review the published clinical data assessing the role of amil oride in the prevention of amphotericin B (AmB)-induced electrolyte disorde rs. DATA SOURCES: A MEDLINE search (January 1966-April 1999) of English-languag e literature pertaining to AmB, amiloride, potassium, and magnesium was per formed. Tertiary sources were also used. DATA EXTRACTION: In vivo and in vitro human and animal data and case report s were included due to the lack of published clinical trails. DATA SYNTHESIS: AmB administration can result in severe hypokalemia and hyp omagnesemia requiring chronic supplementation. In one prospective, controll ed study of hypokalemia with AmB administration, patients receiving concomi tant amiloride had significantly greater potassium concentrations (p < 0.01 ) and required significantly less potassium supplementation (p < 0.001). Am iloride may also reduce the amount of magnesium supplementation required by sparing elimination through the kidneys. CONCLUSIONS: Amiloride may be considered for the prevention of AmB-induced hypokalemia and hypomagnesemia, especially in patients at high risk for com plications resulting from these electrolyte disorders. Further studies are needed to assess concomitant use of other potassium-sparing diuretics and A mB.