title: Spironolactone: is it a novel drug for the prevention of amphotericin B-related hypokalemia in cancer patients?
abstract: OBJECTIVE
  Nephrotoxicity is the major adverse effect of amphotericin B (AmB), often limiting administration of full dosage. Selective distal tubular epithelial toxicity seems to be responsible for the profound potassium wasting that is a major clinical side effect of treatment with AmB. Potassium depletion also potentiates the tubular toxicity of AmB. This study was designed to assess the ability of spironolactone to reduce potassium requirements and to prevent hypokalemia in neutropenic patients on AmB treatment.
  
  
  METHODS
  In this study 26 patients with various hematological disorders were randomized to receive either intravenous AmB alone or AmB and oral spironolactone 100 mg twice daily when developing a proven or suspected fungal infection.
  
  
  RESULTS
  Patients receiving concomitant AmB and spironolactone had significantly higher plasma potassium levels than those receiving AmB alone (P = 0.0027). Those patients receiving AmB and spironolactone required significantly less potassium supplementation to maintain their plasma potassium within the normal range (P = 0.022). Moreover, urinary potassium losses were significantly less in patients receiving AmB and spironolactone than those receiving AmB alone (P = 0.040).
  
  
  CONCLUSIONS
  This study showed that spironolactone can reduce potassium requirements and prevent hypokalemia by reducing urinary potassium loss in neutropenic patients on AmB treatment.
authors.affiliation: Gulhane Military Medical Academy, School of Medicine, Department of Hematology, Etlik, Ankara, Turkey. aliugurum@yahoo.com
authors.forename: A Ugur
authors.initials: AU
authors.lastname: Ural
authors.forename: Ferit
authors.initials: F
authors.lastname: Avcu
authors.forename: Turker
authors.initials: T
authors.lastname: Cetin
authors.forename: Cengiz
authors.initials: C
authors.lastname: Beyan
authors.forename: Kursad
authors.initials: K
authors.lastname: Kaptan
authors.forename: N Kemal
authors.initials: NK
authors.lastname: Nazaroglu
authors.forename: Atilla
authors.initials: A
authors.lastname: Yalcin
mesh_terms: D000666:Amphotericin B / Q000009:adverse effects* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced* / Q000517:prevention & control*; D007677:Kidney Function Tests; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009181:Mycoses / Q000150:complications / Q000188:drug therapy; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000097:blood / Q000150:complications; D011188:Potassium / Q000097:blood / Q000627:therapeutic use / Q000652:urine; D013148:Spironolactone / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000666:Amphotericin B; D011188:Potassium