Nalazite se na CroRIS probnoj okolini. Ovdje evidentirani podaci neće biti pohranjeni u Informacijskom sustavu znanosti RH. Ako je ovo greška, CroRIS produkcijskoj okolini moguće je pristupi putem poveznice www.croris.hr
izvor podataka: crosbi

Hyperkalaemia associated with hydroxyurea in a patient with polycythaemia vera (CROSBI ID 212146)

Prilog u časopisu | prikaz, osvrt, kritika

Marušić, Srečko ; Gojo-Tomić, Nives ; Bačić-Vrca, Vesna ; Božikov, Velimir Hyperkalaemia associated with hydroxyurea in a patient with polycythaemia vera // European journal of clinical pharmacology, 67 (2011), 7; 757-758. doi: 10.1007/s00228-010-0962-7

Podaci o odgovornosti

Marušić, Srečko ; Gojo-Tomić, Nives ; Bačić-Vrca, Vesna ; Božikov, Velimir

engleski

Hyperkalaemia associated with hydroxyurea in a patient with polycythaemia vera

Hydroxyurea has been used for decades for the treatment of some types of malignancies [1]. It was demonstrated to be very effective in preventing thrombosis and thus should be considered as first-line therapy in high-risk patients with myeloproliferative disorders [2]. An 81-year-old lady was admitted to hospital in December 2009 because of hyperkalaemia. Her medical history included essential hypertension for the last 15 years. She had been diagnosed with polycythemia vera in April 2007 and an initial treatment consisted of phlebotomy and low-dose acetylsalicylic acid. In May 2009 the patient had developed iliofemoral vein thrombosis as a consequence of polycythemia vera. To prevent further thromboembolic complications, therapy with hydroxyurea had been introduced. At the time of admission, the patient's therapy included ramipril 2.5 mg, acetylsalicylic acid 100 mg and hydroxyurea 1000 mg daily. Serum potassium level was 6.7 mmol/L (normal range 3.9- 5.1 mmol/L). Levels of sodium, chloride, calcium, lactate dehydrogenase and creatine kinase were all within normal values. Haemoglobin concentration, haematocrit, white and red blood cells and platelet count were normal as were values for plasma aldosteron, plasma renin activity and 24- hour urinary free cortisol. Arterial blood pH and bicarbonates were mildly decreased (pH 7.318, bicarbonates 18.9 mmol/L). Patient's renal function was decreased with serum creatinine of 116 µmol/L and 24-hour creatinine clearance of 41.7 ml/min. Electrocardiogram (ECG) showed no abnormality. Since there was no significant difference between serum and plasma potassium level, pseudohyperkalaemia could have been excluded [3]. Because of the possibility that hyperkalaemia was caused by ramipril or acetylsalicylic acid, therapy with these drugs was discontinued. Repetitive administration of bicarbonate and insulin/glucose did not decrease the potassium level and after seven days it remained high (5.8-6.4 mmol/L). The degree of hyperkalaemia could not have been explained by moderate renal insufficiency and the clinical investigation did not find any other possible cause. Thus, we suspected that it could be an adverse reaction to hydroxyurea. Therapy with hydroxyurea was discontinued and two days later potassium level decreased to 5.0 mmol/L. Since hyperkalaemia was not listed as an adverse reaction in the Summary of Product Characteristics and no similar cases were reported in literature, we were not convinced that it was really caused by hydroxyurea. Hyperkalaemia was asymptomatic and caused no ECG changes in presented case, so we believed that rechallenge would not endanger the patient. After Ethics Review Board approval she was re-administered with 500 mg of hydroxyurea daily. After the second dose, serum potassium level increased to 6.2 mmol/L. Hydroxyurea was stopped and in two days potassium level decreased to 4.9 mmol/L and remained normal during three months of follow up. Hyperkalaemia may result from increased potassium intake, impaired distribution of potassium between the intracellular and extracellular space, and impaired renal excretion of potassium [4]. Medications can cause hyperkalaemia through either of the above mechanisms [5]. In present case, other possible causes of hyperkalaemia were excluded by diagnostic tests. The time relationship of drug administration and hyperkalaemia development, positive dechallenge and rechallenge support the hypothesis of hydroxyurea caused hyperkalaemia. According to the Naranjo's algorithm, hydroxyurea induced hyperkalaemia was rated 'highly probable' [6]. Reviewing the literature, we identified no similar case reports. This adverse drug reaction was reported to the Croatian Agency for Medicinal Products and Medical Devices. In a feedback letter we have been informed that this was the only case of hyperkalaemia associated with hydroxyurea reported to the WHO Collaborating Centre for International Drug Monitoring (WHO, UMC, VigiBase, 02 September, 2010). Hyperkalaemia can induce life- threatening cardiac arrhythmias. Considering that, we conclude that clinicians should be aware of this serious adverse reaction occurring during the use of hydroxyurea.

adverse drug reaction; hyperkalemia; hydroxyurea

nije evidentirano

nije evidentirano

nije evidentirano

nije evidentirano

nije evidentirano

nije evidentirano

Podaci o izdanju

67 (7)

2011.

757-758

objavljeno

0031-6970

10.1007/s00228-010-0962-7

Povezanost rada

Farmacija

Poveznice
Indeksiranost