Table 6.
Miscellaneous.
| Electrolyte disorder | Drug |
Incidence (%) Type of study |
Mechanism(s) |
|---|---|---|---|
| Hyponatremia |
VINCA ALKALOIDS (Vincristine, Vinblastin)
ANTIMETABOLITES Methotrexate TOPOISOMERASE I inhibitor Irinotecan |
11-90 (D) (135–137) 6.6 (120-130 mEq/L) (D)(141) |
SIADH (direct hypothalamic toxicity; potentiated by antifungal azoles) (138, 139) SIADH, CNS-derived natriuretic peptide secretion (142, 143) SIADH (32, 141) |
| Hypokalemia | ANTIMETABOLITES Methotrexate Pemetrexed Azacytidine |
Impairment of ion channels of skeletal muscle myocytes; renal tubular acidosis (144) Acute tubular necrosis; tubular acidosis or acquired FS (145, 146) |
|
| ANTIANDROGENS (Abiraterone) Octreotide |
16.6-18 (D) (all grade) 2.6-4.4 (<3.0 mEq/L) (66, 147, 148). |
17α-hydroxylase inhibition and accumulation of mineralocorticoids (149) Decreased cellular potassium uptake due to insulin suppression (34) |
|
| Hypocalcemia | VINCA ALKALOIDS (Vinblastine) ESTROGENIC AGENTS Estramustine ANTIBIOTICS Mithramycine, Actinomycin D, Actinomycin-F |
Altered intracellular calcium homeostasis due to cell microtubular damage (118) Inhibition of PTH action on bone turnover (67, 150) Blockade of osteoclast function; resistance to PTH on bone turnover (151) |
|
| ANTIMETABOLITES 5-Fluorouracil (combined with leucovorin) TRPV6 INHIBITOR (Soricidin 13) |
65 (D) (152) 13 (D) (153) |
Low vitamin D3 due to reduced 1-alpha-and 25-hydroxylase activities (152) Altered Calcium absorption (153) |
|
| Hypophosphatemia | ESTROGENIC AGENTS (Estramustine) NITROSUREAS (Streptozocin,Semustin,Carmustine, Lomustine) ANTIMETABOLITES Azacytidine |
High phosphaturia due to down-regulation of NaPi-IIa, NaPi-IIc cotransporter in proximal tubule (150) Phosphate wasting due to -interstitial nephritis and tubular atrophy; FS (154) Proximal Tubule Damage (145, 146) |
|
| HALICONDRIN ANALOGUE (Eribuline Mesylate) ANTIBIOTICS (Anthracyclines: amrubicin, doxorubicin) |
8.6 (D) (155, 156) <2.0 mg (A) (157) |
Unclear (155, 156) Proximal Tubule Damage (157) |
Incidence and type of study column: the letter after the percentage indicates the type of evidence available: A isolated case; B case series; C pharmacovigilance notifications or registry; D observational study, clinical trial, metanalysis of clinical trials. n.a. not available. References in bracket square. CNS, Central Nervous System; FS= Fanconi Syndrome; NaPi, Sodium-Phosphate cotransporters; SIADH, Syndrome of inappropriate antidiuretic hormone secretion; TRPV6, inhibition of member six of Transient Receptor Potential Vanilloid family of calcium channel.