Role of diuretics and lipid formulations in the prevention of amphotericin B-induced nephrotoxicity.
OBJECTIVE
To collect available clinical data to define the role of diuretics and lipid formulations in the prevention of amphotericin B (AmB)-induced nephrotoxicity (AIN) in human populations.


METHODS
A literature search was performed in the following databases: Scopus, Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews.


CONCLUSIONS
Co-administration of mannitol failed to show any clinically significant benefit in preventing AIN. Potassium-sparing diuretics, such as amiloride and spironolactone, have been shown to have beneficial effects as an alternative or adjunct to oral/parenteral potassium supplements in preventing hypokalemia due to AmB. Lipid-based formulations of AmB are clinically effective and safe in preventing AIN. However, due to their high cost and limited accessibility, these formulations are generally used as second-line antifungal therapy in cases of conventional AmB refractoriness and/or intolerance or pre-existing renal dysfunction. The potential effects of other nephroprotective agents, such as N-acetylcysteine, AIN merit further considerations and investigations.
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, P.O. Box14155/6451, Tehran, 1417614411, Iran.
Iman
I
Karimzadeh
Hossein
H
Khalili
Shadi
S
Farsaei
Simin
S
Dashti-Khavidaki
Mohammad Mahdi
MM
Sagheb
D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects*; D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003102:Colloids / Q000737:chemistry; D004232:Diuretics / Q000627:therapeutic use*; D006801:Humans; D007008:Hypokalemia / Q000209:etiology / Q000517:prevention & control*; D008055:Lipids / Q000737:chemistry*; D008081:Liposomes / Q000737:chemistry; D014677:Pharmaceutical Vehicles / Q000737:chemistry*; D051437:Renal Insufficiency / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*
D000890:Anti-Infective Agents; D003102:Colloids; D004232:Diuretics; D008055:Lipids; D008081:Liposomes; D014677:Pharmaceutical Vehicles; D000666:Amphotericin B