Evaluation of hypokalemia and potassium supplementation during administration of liposomal-amphotericin B

Abstract

Patients prescribed liposomal-amphotericin B (L-AMB) frequently require supplemental potassium to prevent hypokalemia. The aim of this retrospective study was to examine the appropriate potassium supplementation conditions to treat hypokalemia induced by L-AMB. The subjects were 100 hematological patients who received L-AMB for the first time between April 2012 and March 2013. A total of seven patients were excluded. Of the remaining 93 patients, 48 (51.6%) were assigned to the group receiving supplemental potassium (supplementation group), and 45 (48.4%) were assigned to the group without potassium supplementation (non-supplementation group). Hypokalemia greater than grade 3 was exhibited by 50 of the 93 (53.8%) patients. Multivariate analysis revealed that the minimum serum potassium levels during L-AMB administration (≤2.98 mEq/l) were an independent factor significantly contributing to the effectiveness of potassium supplementation [odds ratio (OR), 3.62; 95% confidence interval (CI), 1.44–9.59; P<0.01]. In addition, multivariate analysis revealed that the serum potassium levels (≥2.83 mEq/l) prior to the potassium supplementation were an independent factor significantly contributing to the development of proper potassium supplementation (OR, 14.21; 95% CI, 1.95–310.72; P=0.02), and no significant difference was observed in the dosage of the potassium supplementation administered to the patients who recovered from hypokalemia and those who did not. In conclusion, it is necessary to begin potassium supplementation prior to the reduction of the serum potassium levels to <2.83 mEq/l. Potassium supplementation at an early stage of L-AMB treatment is important to prevent severe electrolyte abnormalities.

The cost‐effectiveness of isavuconazole compared to voriconazole, the standard of care in the treatment of patients with invasive mould diseases, prior to differential pathogen diagnosis in Spain

“…The model includes adverse events reported in the SECURE study 15 for which statistically significant differences between isavuconazole and voriconazole treatments were found (see Table 3). For the treatment with L‐AMB, unlike the UK original model, nephrotoxicity 37 (associated with 9 days of additional hospital treatment 29 ) and hypokalaemia 38 were also considered. All the costs of adverse events were calculated from Spanish health system reference costs as the mean of the latest published prices for related specialist outpatient visit in autonomous communities 36 .…”

Adverse Drug Reactions in Patients Receiving Systemic Antifungal Therapy at a High‐Complexity Hospital

“…These measures should be adopted during the early treatment phase and are important to prevent severe electrolyte abnormalities. [32][33][34] Hepatotoxicity was mainly induced by triazoles in this study, and voriconazole was associated with the highest number of cases. Hepatotoxicity was also caused by fluconazole, caspofungin, and liposomal amphotericin B.…”

“…Thus, serum potassium level should be monitored periodically during treatment with amphotericin B, and potassium supplementation should be provided. These measures should be adopted during the early treatment phase and are important to prevent severe electrolyte abnormalities …”

Acute Peripheral Motor Neuropathy Induced by Oxaliplatin-Correlated Hypokalaemia

“…Lyposomial amphotericin B is a powerful antifungal agent used to treat systemic mycosis. The drug has to be prepared in glucose 5% prior to infusion, and one of the most common side effects is hypokalaemia [15,16]. This side effect of the drug is seen so frequently that preemptive treatment strategies with potassium tablets are standardly recommended.…”