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

OBJECTIVE: To review the published clinical data assessing the role of amiloride in the prevention of amphotericin B (AmB)–induced electrolyte disorders. DATA SOURCES: A MEDLINE search (January 1966–April 1999) of English-language literature pertaining to AmB, amiloride, potassium, and magnesium was performed. Tertiary sources were also used. DATA EXTRACTION: In vivo and in vitro human and animal data and case reports were included due to the lack of published clinical trials. DATA SYNTHESIS: AmB administration can result in severe hypokalemia and hypomagnesemia requiring chronic supplementation. In one prospective, controlled study of hypokalemia with AmB administration, patients receiving concomitant amiloride had significantly greater potassium concentrations (p < 0.01) and required significantly less potassium supplementation (p < 0.001). Amiloride 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 complications resulting from these electrolyte disorders. Further studies are needed to assess concomitant use of other potassium-sparing diuretics and AmB.