Heleno Caio T, Miranda Helena, Gotera Nico, Kloecker Goetz
Hematology and Oncology, University of Louisville, Louisville, USA.
Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Cureus. 2024 Jun 17;16(6):e62546. doi: 10.7759/cureus.62546. eCollection 2024 Jun.
Cisplatin, a chemotherapy agent widely used since its FDA approval in 1978 for testicular cancer, is associated with nephrotoxicity and hypomagnesemia. Magnesium supplementation is not only a treatment for hypomagnesemia but also a well-established agent in preventing cisplatin-induced nephrotoxicity (CIN). Considering the challenges associated with intravenous magnesium use and even with the supplementation of oral forms, there is a need for drugs that effectively reduce urinary magnesium excretion. Amiloride and sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) have emerged as potential candidates. Amiloride is a well-known potassium-sparing diuretic that also has a hypomagnesemia effect seen in preclinical data. SGLT2 inhibitors are a drug class initially used in diabetes that was also observed to have positive effects on cardiovascular mortality, diabetic kidney disease, and hypomagnesemia. SGLT2 inhibitors were found to reduce hypomagnesemia in a meta-analysis study of 18 trials. However, these trials were not specifically designed for the evaluation of hypomagnesemia, and their current use in hypomagnesemia is considered off-label.
顺铂是一种自1978年被美国食品药品监督管理局批准用于治疗睾丸癌以来广泛使用的化疗药物，它与肾毒性和低镁血症有关。补充镁不仅是治疗低镁血症的方法，也是预防顺铂诱导的肾毒性（CIN）的一种成熟药物。考虑到静脉使用镁甚至口服补充镁所带来的挑战，需要有效减少尿镁排泄的药物。氨氯吡咪和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2抑制剂）已成为潜在的候选药物。氨氯吡咪是一种著名的保钾利尿剂，在临床前数据中也有低镁血症的作用。SGLT2抑制剂最初用于治疗糖尿病，也被观察到对心血管死亡率、糖尿病肾病和低镁血症有积极作用。在一项对18项试验的荟萃分析研究中发现，SGLT2抑制剂可降低低镁血症。然而，这些试验并非专门设计用于评估低镁血症，它们目前在低镁血症中的使用被认为是超说明书用药。
