Abstract
Nearly 50 medications have been implicated as inducing hypomagnesaemia, sometimes based on insufficient data regarding clinical significance and frequency of occurrence. In fact, clinical effects attributed to hypomagnaesemia have been reported in only 17 of these drugs. A considerable amount of literature relating to individual drugs has been published, yet a comprehensive overview of this issue is not available and the hypomagnesaemic effect of a drug could be either overemphasised or under-rated. In addition, there are neither guidelines regarding treatment, prevention and monitoring of drug-induced hypomagnesaemia nor agreement as to what serum level of magnesium may actually be defined as ‘hypomagnesaemia’.
By compiling data from published papers, electronic databases, textbooks and product information leaflets, we attempted to assess the clinical significance of hypomagnesaemia induced by each drug. A practical approach for managing drug-induced hypomagnesaemia, incorporating both published literature and personal experience of the physician, is proposed. When drugs classified as inducing ‘significant’ hypomagnesaemia (cisplatin, amphotericin B, ciclosporin) are administered, routine magnesium monitoring is warranted, preventive treatment should be considered and treatment of hypomagnesaemia should be initiated with or without overt clinical manifestations. In drugs belonging to the ‘potentially significant’ category, among which are amikacin, gentamicin, laxatives, pentamidine, tobramycin, tacrolimus and carboplatin, magnesium monitoring is justified when either of the following occurs: clinical manifestations are apparent; persistent hypokalaemia, hypocalcaemia or alkalosis are present; other precipitating factors for hypomagnesaemia coexist; or treatment is with more than one potentially hypomagnesaemic drug. No preventive treatment is required and treatment should be initiated only if hypomagnesaemia is accompanied by symptoms or clinically significant relevant laboratory findings. In those drugs whose hypomagnesaemic effect is labelled as ‘questionable’, including furosemide and hydrochlorothiazide, routine monitoring and treatment are not required.
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References
Salem M, Kasinski N, Andrei AM, et al. Hypomagnesemia is a frequent finding in the emergency department in patients with chest pain. Arch Intern Med 1991; 151: 2185–90
Lum G. Hypomagnesemia in acute and chronic care patient populations. Am J Clin Pathol 1992; 97: 827–30
Wong ET, Rude RK, Singer FR, et al. A high prevalence of hypomagnesemia and hypermagnesemia in hospitalized patients. Am J Clin Pathol 1983; 79: 348–52
Chernow B, Bamberger S, Stoiko M, et al. Hypomagnesemia in patients in postoperative intensive care. Chest 1989; 95: 391–7
Ryzen E. Magnesium homeostasis in critically ill patients. Magnesium 1989; 8: 201–12
Whang R, Ryder KW. Frequency of hypomagnesemia and hypermagnesemia: requested vs routine. JAMA 1990; 263: 3063–4
Agus ZS. Hypomagnesemia. J Am Soc Nephrol 1999; 10: 1616–22
al-Ghamdi SM, Cameron EC, Sutton RA. Magnesium deficiency: pathophysiology and clinical overview. Am J Kidney Dis 1994; 24: 737–52
Weisinger JR, Bellorin-Font E. Magnesium and phosphorus. Lancet 1998; 352: 391–6
Nadler JL, Rude RK. Disorders of magnesium metabolism. Endocrinol Metab Clin North Am 1995; 24: 623–41
Sanders GT, Huijgen HJ, Sanders R. Magnesium in disease: a review with special emphasis on the serum ionized magnesium. Clin Chem Lab Med 1999; 37: 1011–33
Keating MJ, Sethi MR, Bodey GP, et al. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977; 39: 1410–4
Campo S, Breda E, Di Girolamo M. Hypomagnesaemia on antibiotic therapy. Postgrad Med J 1988; 64: 336–7
Shah GM, Kirschenbaum MA. Renal magnesium wasting associated with therapeutic agents. Miner Electrolyte Metab 1991; 17: 58–64
Darr M, Hamburger S, Ellerbeck E. Acid-base and electrolyte abnormalities due to capreomycin. South Med J 1982; 75: 627–8
Steiner RW, Omachi AS. A Bartter’s-like syndrome from capreomycin, and a similar gentamicin tubulopathy. Am J Kidney Dis 1986; 7: 245–9
Bar RS, Wilson HE, Mazzaferri EL. Hypomagnesaemic hypocalcemia secondary to renal magnesium wasting. Ann Intern Med 1975; 82: 646–9
Kelnar CJ, Taor WS, Reynolds DJ, et al. Hypomagnesaaemic hypocalcaemia with hypokalaemia caused by treatment with high dose gentamicin. Arch Dis Child 1978; 53: 817–20
Winaver Y, Rapoport J, Vardi Y. Magnesium-losing nephropathy due to gentamicin. Harefuah 1982; 103: 306–7
Landau D, Kher KK. Gentamicin-induced Bartter-like syndrome. Pediatr Nephrol 1997; 11: 737–40
Nanji AA, Denegri JF. Hypomagnesemia associated with gentamicin therapy. Drug Intell Clin Pharm 1984; 18: 596–8
Patel R, Savage A. Symptomatic hypomagnesemia associated with gentamicin therapy. Nephron 1997; 23: 50–2
Tezic T, Saraclar Y, Bilginturan N, et al. Symptomatic hypocalcemia and hypomagnesemia due to gentamicin therapy in an 8-year-old girl [abstract]. Turk J Pediatr 1982; 24: 267–9
Kes P, Reiner Z. Symptomatic hypomagnesemia associated with gentamicin therapy. Magnes Trace Elem 1990; 9: 54–60
Shetty AK, Rogers NL, Mannick EE, et al. Syndrome of hypokalaemic metabolic alkalosis and hypomagnesemia associated with gentamicin therapy: case reports. Clin Pediatr 2000; 39: 529–33
Shiah CJ, Tsai DM, Liao ST, et al. Acute muscular paralysis in an adult with subclinical Bartter’s syndrome associated with gentamicin administration. Am J Kidney Dis 1994; 24: 932–5
Elliott C, Newman N, Madan A. Gentamicin effects on urinary electrolyte excretion in healthy subjects. Clin Pharmacol Ther 2000; 67: 16–21
Zaloga GP, Chernow B, Pock A, et al. Hypomagnesemia is a common complication of aminoglycoside therapy. Surg Gynecol Obstet 1984; 158: 561–5
Drugan A, Itskovitz J, Fisher M, et al. Hypokalemia, hypocalcemia and hypomagnesemia associated with gentamicin [in Hebrew]. Harefuah 1980; 99: 77–8
Wilkinson R, Lucas GL, Heath DA, et al. Hypomagnesaaemic tetany associated with prolonged treatment with aminoglycosides. BMJ 1986; 292: 818–9
Davies SV, Murray JA. Amphotericin B, aminoglycosides, and hypomagnesaaemic tetany. BMJ 1986; 292: 1395–6
Mayer J, Doubek M, Vorlicek J. Must we really fear toxicity of conventional amphotericin B in oncological patients? Support Care Cancer 1999; 7: 51–5
Wazny LD, Brophy DF. Amiloride for the prevention of amphotericin B-induced hypokalemia and hypomagnesemia. Ann Pharmacother 2000; 34: 94–7
Webb DE, Austin III HA, Belldegrun A, et al. Metabolic and renal effects of interleukin-2 immunotherapy for metastatic cancer. Clin Nephrol 1988; 30: 141–5
Lajer H, Daugaard G. Cisplatin and hypomagnesemia. Cancer Treat Rev 1999; 25: 47–58
Hayes FA, Green AA, Casper J, et al. Clinical evaluation of sequentially scheduled cisplatin and VM26 in neuroblastoma: response and toxicity. Cancer 1981; 48: 1715–8
Maina A, Richiardi G, Danese S, et al. Symptomatic hypocalcemia and hypomagnesiemia in cisplatinum-based chemotherapy treated patients: case report. Eur J Gynaecol Oncol 1996; 17: 281–2
Al-Tweigeri T, Magliocco AM, DeCoteau JF. Cortical blindness as a manifestation of hypomagnesemia secondary to cisplatin therapy: case report and review of literature. Gynecol Oncol 1999; 72: 120–2
Gomez Campdera FJ, Gonzalez P, Carrillo A, et al. Cisplatin nephrotoxicity: symptomatic hypomagnesemia and renal failure. Int J Pediatr Nephrol 1986; 7: 151–2
Gonzalez C, Villasanta U. Life-threatening hypocalcemia and hypomagnesemia associated with cisplatin chemotherapy. Obstet Gynecol 1982; 59: 732–4
Hill JB, Russo A. Cisplatin-induced hypomagnesaemic hypocalcemia [letter]. Arch Intern Med 1981; 141: 1100
Stuart-Harris R, Ponder BA, Wrigley PF. Tetany associated with cis-platinm [letter]. Lancet 1980; II: 1303
Lyman NW, Hemalatha C, Viscuso RL, et al. Cisplatin-induced hypocalcemia and hypomagnesemia. Arch Intern Med 1980; 140: 1513–4
Mune T, Katakami H, Morita M, et al. Increased serum immunoreactive parathyroid hormone-related protein levels in chronic hypocalcemia. J Clin Endocrinol Metab 1994; 78: 575–80
Posner MR, Glisson B, Frenette G, et al. Multicenter phase I-II trial of docetaxel, cisplatin, and fluorouracil induction chemotherapy for patients with locally advanced squamous cell cancer of the head and neck. J Clin Oncol 2001; 19: 1096–104
Schilsky RL, Anderson T. Hypomagnesemia and renal magnesium wasting in patients receiving cisplatin. Ann Intern Med 1979; 90: 929–31
Stewart AF, Keating T, Schwartz PE. Magnesium homeostasis following chemotherapy with cisplatin: a prospective study. Am J Obstet Gynecol 1985; 153: 660–5
Hayes FA, Green AA, Senzer N, et al. Tetany: a complication of cis-dichlorodiammineplatinum(II) therapy. Cancer Treat Rep 1979; 63: 547–8
Winter RJ, Harris CJ, Phillips LS, et al. Diabetic ketoacidosis: induction of hypocalcemia and hypomagnesemia by phosphate therapy. Am J Med 1979; 67: 897–900
Willox JC, McAllister EJ, Sangster G, et al. Effects of magnesium supplementation in testicular cancer patients receiving cisplatin: a randomised trial. Br J Cancer 1986; 54: 19–23
Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to cisplatin-induced magnesium depletion. Arch Intern Med 1989; 149: 2592–4
Gradon JD, Fricchione L, Sepkowitz D. Severe hypomagnesemia associated with pentamidine therapy. Rev Infect Dis 1991; 13: 511–2
Shah GM, Alvarado P, Kirschenbaum MA. Symptomatic hypocalcemia and hypomagnesemia with renal magnesium wasting associated with pentamidine therapy in a patient with AIDS. Am J Med 1990; 89: 380–2
Huycke MM, Naguib MT, Stroemmel MM, et al. A double-blind placebo-controlled crossover trial of intravenous magnesium sulfate for foscarnet-induced ionized hypocalcemia and hypomagnesemia in patients with AIDS and cytomegalovirus infection. Antimicrob Agents Chemother 2000; 44: 2143–8
Gearhart MO, Sorg TB. Foscarnet-induced severe hypomagnesemia and other electrolyte disorders. Ann Pharmacother 1993; 27: 285–9
Elisaf M, Kalaitzidis R, Siamopoulos KC. Multiple electrolyte abnormalities after pamidronate administration. Nephron 1998; 79: 337–9
Aredia® prescribing information. East Hanover (NJ): Novartis Pharmaceuticals Corporation, 2001
Escalante CP, Weiser MA, Finkel K. Hyperphosphatemia associated with phosphorus-containing laxatives in a patient with chronic renal insufficiency. South Med J 1997; 90: 240–2
Shaoul R, Wolff R, Seligmann H, et al. Symptoms of hyperphosphatemia, hypocalcemia, and hypomagnesemia in an adolescent after the oral administration of sodium phosphate in preparation for a colonoscopy. Gastrointest Endosc 2001; 53: 650–2
Ehrenpreis ED, Wieland JM, Cabral J, et al. Symptomatic hypocalcemia, hypomagnesemia, and hyperphosphatemia secondary to Fleet’s Phospho-Soda colonoscopy preparation in a patient with a jejunoileal bypass. Dig Dis Sci 1997; 42: 858–60
Boivin MA, Kahn SR. Symptomatic hypocalcemia from oral sodium phosphate: a report of two cases. Am J Gastroenterol 1998; 93: 2577–9
Ehrenpreis ED, Nogueras JJ, Botoman VA, et al. Serum electrolyte abnormalities secondary to Fleet’s Phospho-Soda colonoscopy prep: a review of three cases. Surg Endosc 1996; 10: 1022–4
Glover D, Riley L, Carmichael K, et al. Hypocalcemia and inhibition of parathyroid hormone secretion after administration of WR-2721 (a radioprotective and chemoprotective agent). N Engl J Med 1983; 309: 1137–41
Zipf WB, Bacon GE, Spencer ML, et al. Hypocalcemia, hypomagnesemia, and transient hypoparathyroidism during therapy with potassium phosphate in diabetic ketoacidosis. Diabetes Care 1979; 2: 265–8
Hagley MT, Traeger SM, Schuckman H. Pronounced metabolic response to modest theophylline overdose. Ann Pharmacother 1994; 28: 195–6
Hall KW, Dobson KE, Dalton JG, et al. Metabolic abnormalities associated with intentional theophylline overdose. Ann Intern Med 1984; 101: 457–62
Flack JM, Ryder KW, Strickland D, et al. Metabolic correlates of theophylline therapy: a concentration-related phenomenon. Ann Pharmacother 1994; 28: 175–9
Chou CL, Chen YH, Chau T, et al. Acquired bartter-like syndrome associated with gentamicin administration. Am J Med Sci 2005; 329: 144–9
Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996; 89: 1108–10
Narita M, Itakura O, Ishiguro N, et al. Hypomagnesaemia-associated tetany due to intravenous administration of amphotericin B. Eur J Pediatr 1997; 156: 421–2
McKee MD, Cecco SA, Niemela JE, et al. Effects of interleukin 2 therapy on lymphocyte magnesium levels. J Lab Clin Med 2002; 139: 5–12
Bell DR, Woods RL, Levi JA. cis-Diamminedichloroplatinum-induced hypomagnesemia and renal magnesium wasting. Eur J Cancer Clin Oncol 1985; 21: 287–90
Dorup I, Skajaa K, Thybo NK. Oral magnesium supplementation restores the concentrations of magnesium, potassium and sodium-potassium pumps in skeletal muscle of patients receiving diuretic treatment. J Intern Med 1993; 233: 117–23
Majumdar G. Severe hypomagnesaemia with tetany following ESHAP protocol. BMC Blood Disord 2002; 2: 1
Schilsky RL, Barlock A, Ozols RF. Persistent hypomagnesemia following cisplatin chemotherapy for testicular cancer. Cancer Treat Rep 1982; 66: 1767–9
Bellin SL, Selim M. Cisplatin-induced hypomagnesemia with seizures: a case report and review of the literature. Gynecol Oncol 1988; 30: 104–13
Ashraf M, Scotchel PL, Krall JM, et al. cis-Platinum-induced hypomagnesemia and peripheral neuropathy. Gynecol Oncol 1983; 16: 309–18
Barton CH, Vaziri ND, Martin DC, et al. Hypomagnesemia and renal magnesium wasting in renal transplant recipients receiving cyclosporine. Am J Med 1987; 83: 693–9
Thompson CB, June CH, Sullivan KM, et al. Association between cyclosporin neurotoxicity and hypomagnesaemia. Lancet 1984; II: 1116–20
Navazo L, Salata H, Morales S, et al. Oral microemulsion cyclosporine in the treatment of steroid-refractory attacks of ulcerative and indeterminate colitis. Scand J Gastroenterol 2001; 36: 610–4
Cavdar C, Sifil A, Sanli E, et al. Hypomagnesemia and mild rhabdomyolysis in living related donor renal transplant recipient treated with cyclosporine A. Scand J Urol Nephrol 1998; 32: 415–7
Yanik G, Levine JE, Ratanatharathorn V, et al. Tacrolimus (FK506) and methotrexate as prophylaxis for acute graftversus-host disease in pediatric allogeneic stem cell transplantation. Bone Marrow Transplant 2000; 26: 161–7
Iannello S, Spina M, Leotta P, et al. Hypomagnesemia and smooth muscle contractility: diffuse esophageal spasm in an old female patient. Miner Electrolyte Metab 1998; 24: 348–56
Buckley JE, Clark VL, Meyer TJ, et al. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984; 144: 2347–8
Ito Y, Arahata Y, Goto Y, et al. Cisplatin neurotoxicity presenting as reversible posterior leukoencephalopathy syndrome. Am J Neuroradiol 1998; 19: 415–7
Planting AS, de Mulder PH, de Graeff A, et al. Phase II study of weekly high-dose cisplatin for six cycles in patients with locally advanced squamous cell carcinoma of the head and neck. Eur J Cancer 1997; 33: 61–5
van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000; 39: 239–40
Goldstein LS, Haug III MT, Perl II J, et al. Central nervous system complications after lung transplantation. J Heart Lung Transplant 1998; 17: 185–91
Drachman BM, DeNofrio D, Acker MA, et al. Cortical blindness secondary to cyclosporine after orthotopic heart transplantation: a case report and review of the literature. J Heart Lung Transplant 1996; 15: 1158–64
Bernstein L, Levin R. Catatonia responsive to intravenous lorazepam in a patient with cyclosporine neurotoxicity and hypomagnesemia. Psychosomatics 1993; 34: 102–3
Vogelzang NJ, Torkelson JL, Kennedy BJ. Hypomagnesemia, renal dysfunction, and Raynaud’s phenomenon in patients treated with cisplatin, vinblastine, and bleomycin. Cancer 1985; 56: 2765–70
Icli F, Karaoguz H, Dincol D, et al. Severe vascular toxicity associated with cisplatin-based chemotherapy. Cancer 1993; 72: 587–93
Mani S, Kocheril AG, Andriole VT. Case report: pentamidine and polymorphic ventricular tachycardia revisited. Am J Med Sci 1993; 305: 236–40
Wharton JM, Demopulos PA, Goldschlager N. Torsade de pointes during administration of pentamidine isethionate. Am J Med 1987; 83: 571–6
June CH, Thompson CB, Kennedy MS, et al. Correlation of hypomagnesemia with the onset of cyclosporine-associated hypertension in marrow transplant patients. Transplantation 1986; 41: 47–51
al-Khursany I, Thomas TH, Harrison K, et al. Reduced erythrocyte and leukocyte magnesium is associated with cyclosporin treatment and hypertension in renal transplant patients. Nephrol Dial Transplant 1992; 7: 251–5
Moskowitz IP, Gaynon PS, Shahidi NT, et al. Low-dose cyclosporin A therapy in children with refractory immune thrombocytopenic purpura. J Pediatr Hematol Oncol 1999; 21: 77–9
Cronin RE, Knochel JP. Magnesium deficiency. Adv Intern Med 1983; 28: 509–33
Kingston ME, Al-Siba’i MB, Skooge WC. Clinical manifestations of hypomagnesemia. Crit Care Med 1986; 14: 950–4
Crook MA. Hypophosphataemia and hypokalaemia in patients with hypomagnesaemia. Br J Biomed Sci 1994; 51: 24–7
Ryan MP. Interrelationships of magnesium and potassium homeostasis. Miner Electrolyte Metab 1993; 19: 290–5
Whang R, Whang DD, Ryder KW, et al. Routine serum magnesium determination: a contemporary clinical imperative. Magnes Res 1990; 3: 267–70
Edwards BD, Maiza A, Daley-Yates PT, et al. Altered clearance of N-1 methylnicotinamide associated with the use of low doses of cyclosporine. Am J Kidney Dis 1994; 23: 23–30
Gupta AK, Rocher LL, Schmaltz SP, et al. Short-term changes in renal function, blood pressure, and electrolyte levels in patients receiving cyclosporine for dermatologic disorders. Arch Intern Med 1991; 151: 356–62
June CH, Thompson CB, Kennedy MS, et al. Profound hypomagnesemia and renal magnesium wasting associated with the use of cyclosporine for marrow transplantation. Transplantation 1985; 39: 620–4
Vannini SD, Mazzola BL, Rodoni L, et al. Permanently reduced plasma ionized magnesium among renal transplant recipients on cyclosporine. Transpl Int 1999; 12: 244–9
McDiarmid SV. Renal function in pediatric liver transplant patients. Kidney Int Suppl 1996; 53: S77–84
Millane TA, Jennison SH, Mann JM, et al. Myocardial magnesium depletion associated with prolonged hypomagnesemia: a longitudinal study in heart transplant recipients. J Am Coll Cardiol 1992; 20: 806–12
Palestine AG, Austin III HA, Nussenblatt RB. Renal tubular function in cyclosporine-treated patients. Am J Med 1986; 81: 419–24
Markell MS, Altura BT, Barbour RL, et al. Ionized and total magnesium levels in cyclosporin-treated renal transplant recipients: relationship with cholesterol and cyclosporin levels. Clin Sci 1993; 85: 315–8
Lam M, Adelstein DJ. Hypomagnesemia and renal magnesium wasting in patients treated with cisplatin. Am J Kidney Dis 1986; 8: 164–9
O’Brien JG, Dong BJ, Coleman RL, et al. A 5-year retrospective review of adverse drug reactions and their risk factors in human immunodeficiency virus-infected patients who were receiving intravenous pentamidine therapy for Pneumocystis carinii pneumonia. Clin Infect Dis 1997; 24: 854–9
Vithayasai P, Rojanasthien N, Punglumpoo S. A case of hypomagnesemia hypocalcemia as a complication of aminoglycoside and review of the literature [abstract]. J Med Assoc Thai 1989; 72: 413–6
Watson A, Coffey L, Keogh B, et al. Severe hypomagnesaemia and hypocalcaemia following gentamicin therapy. Ir Med J 1983; 76: 381–3
Planells E, Llopis J, Peran F, et al. Changes in tissue calcium and phosphorus content and plasma concentrations of parathyroid hormone and calcitonin after long-term magnesium deficiency in rats. J Am Coll Nutr 1995; 14: 292–8
Mihara M, Kamikubo K, Hiramatsu K, et al. Renal refractoriness to phosphaturic action of parathyroid hormone in a patient with hypomagnesemia. Intern Med 1995; 34: 666–9
Marcus N, Garty BZ. Transient hypoparathyroidism due to amphotericin B-induced hypomagnesemia in a patient with beta-thalassemia. Ann Pharmacother 2001; 35: 1042–4
Winkler CF, Mahr MM, DeBandi H. Cisplatin and renal magnesium wasting. Ann Intern Med 1979; 91: 502–3
Lamer AJ, Sturman SG, Hawkins JB, et al. Myopathy with ragged red fibres following renal transplantation: possible role of cyclosporin-induced hypomagnesaemia. Acta Neuropathol 1984; 88: 189–92
Rock E, Astier C, Lab C, et al. Dietary magnesium deficiency in rats enhances free radical production in skeletal muscle. J Nutr 1995; 125: 1205–10
Morris ME. Brain and CSF magnesium concentrations during magnesium deficit in animals and humans: neurological symptoms. Magnes Res 1992; 5: 303–13
Alexander BS. Diuretic-induced CNS magnesium alteration and digoxin intoxication. Magnesium 1988; 7: 210–8
Allen RD, Hunnisett AG, Morris PJ. Cyclosporin and magnesium. Lancet 1985; I: 1283–4
Craven JL. Cyclosporine-associated organic mental disorders in liver transplant recipients. Psychosomatics 1991; 32: 94–102
Hauben M. Cyclosporine neurotoxicity. Pharmacotherapy 1996; 16: 576–83
Vogt DP, Lederman RJ, Carey WD, et al. Neurologic complications of liver transplantation. Transplantation 1988; 45: 1057–61
Altura BM, Altura BT. Magnesium and cardiovascular biology: an important link between cardiovascular risk factors and atherogenesis. Cell Mol Biol Res 1995; 41: 347–59
Sheehan JP, Seelig MS. Interactions of magnesium and potassium in the pathogenesis of cardiovascular disease. Magnesium 1984; 3: 301–14
Agus MS, Agus ZS. Cardiovascular actions of magnesium. Crit Care Clin 2001; 17: 175–86
Reyes AJ, Leary WP. Cardiovascular toxicity of diuretics related to magnesium depletion. Hum Toxicol 1984; 3: 351–71
Sheehan J, White A. Diuretic-associated hypomagnesaemia. BMJ 1982; 285: 1157–9
Hollifield JW. Thiazide treatment of systaemic hypertension: effects on serum magnesium and ventricular ectopic activity. Am J Cardiol 1989; 63: 22G–5G
Boyd JC, Bruns DE, DiMarco JP, et al. Relationship of potassium and magnesium concentrations in serum to cardiac arrhythmias. Clin Chem 1984; 30: 754–7
Millane TA, Ward DE, Camm AJ. Is hypomagnesemia arrhythmogenic? Clin Cardiol 1992; 15: 103–8
Ohnishi K, Yoshida H, Shigeno K, et al. Prolongation of the QT interval and ventricular tachycardia in patients treated with arsenic trioxide for acute promyelocytic leukemia. Ann Intern Med 2000; 133: 881–5
Nguyen T, Steiner RW. A trial of oral magnesium supplementation in renal transplant recipients receiving cyclosporine. Transplant Proc 1998; 30: 4317–9
Asai T, Nakatani T, Yamanaka S, et al. Magnesium supplementation prevents experimental chronic cyclosporine a nephrotoxicity via renin-angiotensin system independent mechanism. Transplantation 2002; 74: 784–91
Miura K, Nakatani T, Asai T, et al. Role of hypomagnesemia in chronic cyclosporine nephropathy. Transplantation 2002; 73: 340–7
Nozue T, Kobayashi A, Sako A, et al. Evidence that cyclosporine causes both intracellular migration and inappropriate urinary excretion of magnesium in rats. Transplantation 1993; 55: 346–9
Pere AK, Krogerus L, Mervaala EM, et al. Detrimental effect of dietary sodium and beneficial effect of dietary magnesium on glomerular changes in cyclosporin-A-treated spontaneously hypertensive rats. Nephrol Dial Transplant 1998; 13: 904–10
Rob PM, Lebeau A, Nobiling R, et al. Magnesium metabolism: basic aspects and implications of ciclosporine toxicity in rats. Nephron 1996; 72: 59–66
Hodler J, Roulin F, Haldimann B. Short-term effect of thiazides on magnesium and calcium metabolism and secondarily on that of phosphorus, uric acid, oxalate and cyclic AMP [abstract]. Nephrologie 1983; 4: 60–3
Wuermser LA, Reilly C, Poindexter JR, et al. Potassium-magnesium citrate versus potassium chloride in thiazide-induced hypokalemia. Kidney Int 2000; 57: 607–12
Ahlstrand C, Tiselius HG. Metabolic effects of bendroflumethiazide in patients with recurrent calcium oxalate stone disease. J Urol 1981; 126: 635–9
Ariceta G, Rodriguez-Soriano J, Vallo A, et al. Acute and chronic effects of cisplatin therapy on renal magnesium homeostasis. Med Pediatr Oncol 1997; 28: 35–40
Abbasciano V, Mazzotta D, Vecchiatti G, et al. Changes in serum, erythrocyte, and urinary magnesium after a single dose of cisplatin combination chemotherapy. Magnes Res 1991; 4: 123–5
Finton CK, Bjorkland S, Zaloga GP, et al. Gentamicin-induced hypomagnesemia. Am Surg 1983; 49: 576–8
Wu B, Atkinson SA, Halton JM, et al. Hypermagnesiuria and hypercalciuria in childhood leukemia: an effect of amikacin therapy. J Pediatr Hematol Oncol 1996; 18: 86–9
Abraham AS, Brooks BA, Grafstein Y, et al. Effects of hydrochlorothiazide, diltiazem and enalapril on mononuclear cell sodium and magnesium levels in systaemic hypertension. Am J Cardiol 1991; 68: 1357–61
Cohen L, Kitzes R, Shnaider H. The myth of long-term thiazide-induced magnesium deficiency. Magnesium 1985; 4: 176–81
Colussi G, Rombola G, Brunati C, et al. Abnormal reabsorption of Na+/Cl- by the thiazide inhibitable transporter of the distal convoluted tubule in Gitelman’s syndrome. Am J Nephrol 1997; 17: 103–11
Garca Puig J, Miranda ME, Mateos F, et al. Hydrochlorothiazide versus spironolactone: long-term metabolic modifications in patients with essential hypertension. J Clin Pharmacol 1991; 31: 455–61
Siegel D, Hulley SB, Black DM, et al. Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men. JAMA 1992; 267: 1083–9
Costello RB, Moser-Veillon PB. A review of magnesium intake in the elderly: a cause for concern? Magnes Res 1992; 5: 61–7
Hayes JP, Ryan MF, Brazil N, et al. Serum hypomagnesaemia in an elderly day-hospital population. Ir Med J 1989; 82: 117–9
Petri M, Cumber P, Grimes L, et al. The metabolic effects of thiazide therapy in the elderly: a population study. Age Ageing 1986; 15: 151–5
Touitou Y, Godard JP, Ferment O, et al. Prevalence of magnesium and potassium deficiencies in the elderly. Clin Chem 1987; 33: 518–23
Worwag M, Classen HG, Schumacher E. Prevalence of magnesium and zinc deficiencies in nursing home residents in Germany. Magnes Res 1999; 12: 181–9
D’Erasmo E, Celi FS, Acca M, et al. Hypocalcemia and hypomagnesemia in cancer patients. Biomed Pharmacother 1991; 45: 315–7
Frazier TG, Mucha ME, Rush IH, et al. Hypomagnesemia: higher risk using total parenteral nutrition in the treatment of patients with malignancies. J Surg Oncol 1980; 13: 35–8
Milionis HJ, Bourantas CL, Siamopoulos KC, et al. Acid-base and electrolyte abnormalities in patients with acute leukemia. Am J Hematol 1999; 62: 201–7
O’Regan S, Carson S, Chesney RW, et al. Electrolyte and acid-base disturbances in the management of leukemia. Blood 1977; 49: 345–53
Al-Rasheed AK, Blaser SI, Minassian BA, et al. Cyclosporine A neurotoxicity in a patient with idiopathic renal magnesium wasting. Pediatr Neurol 2000; 23: 353–6
Adams JP, Conway SP, Wilson C. Hypomagnesaaemic tetany associated with repeated courses of intravenous tobramycin in a patient with cystic fibrosis. Respir Med 1998; 92: 602–4
Akbar A, Rees JH, Nyamugunduru G, et al. Aminoglycoside-associated hypomagnesaemia in children with cystic fibrosis. Acta Paediatr 1999; 88: 783–5
von Vigier RO, Truttmann AC, Zindler-Schmocker K, et al. Aminoglycosides and renal magnesium homeostasis in humans. Nephrol Dial Transplant 15: 822–6, 2000
Milionis HJ, Alexandrides GE, Liberopoulos EN, et al. Hypomagnesemia and concurrent acid-base and electrolyte abnormalities in patients with congestive heart failure. Eur J Heart Fail 2002; 4: 167–73
Eibl NL, Kopp HP, Nowak HR, et al. Hypomagnesemia in type II diabetes: effect of a 3-month replacement therapy. Diabetes Care 1995; 18: 188–92
Fox CH, Ramsoomair D, Mahoney MC, et al. An investigation of hypomagnesemia among ambulatory urban African Americans. J Fam Pract 1999; 48: 636–9
Garber AJ. Magnesium utilization survey in selected patients with diabetes. Clin Ther 1996; 18: 285–94
Lima Mde L, Cruz T, Pousada JC, et al. The effect of magnesium supplementation in increasing doses on the control of type 2 diabetes. Diabetes Care 1998; 21: 682–6
Rodriguez-Moran M, Guerrero-Romero F. Low serum magnesium levels and foot ulcers in subjects with type 2 diabetes. Arch Med Res 2001; 32: 300–3
Sheehan JP. Magnesium deficiency and diabetes mellitus. Magnes Trace Elem 1991-92; 10: 215–9
Nadler JL, Buchanan T, Natarajan R, et al. Magnesium deficiency produces insulin resistance and increased thromboxane synthesis. Hypertension 1993; 21: 1024–9
Sheehan JP. Magnesium deficiency and diuretics [letter]. BMJ (Clin Res Ed) 1983; 286: 390
Chavanet PY, Garry I, Charlier N, et al. Trial of glucose versus fat emulsion in preparation of amphotericin for use in HIV infected patients with candidiasis. BMJ 1992; 305: 921–5
Kone BC, Whelton A, Santos G, et al. Hypertension and renal dysfunction in bone marrow transplant recipients. Q J Med 1988; 69: 985–95
Lewis R, Durnin C, McLay J, et al. Magnesium deficiency may be an important determinant of ventricular ectopy in digitalised patients with chronic atrial fibrillation. Br J Clin Pharmacol 1991; 31: 200–3
Whang R, Oei TO, Watanabe A. Frequency of hypomagnesemia in hospitalized patients receiving digitalis. Arch Intern Med 1985; 145: 655–6
Young IS, Goh EM, McKillop UH, et al. Magnesium status and digoxin toxicity. Br J Clin Pharmacol 1991; 32: 717–21
Tackett RL, Holl JE. Increased automaticity and decreased inotropism of ouabain in dogs with furosemide-induced hypomagnesemia. J Cardiovasc Pharmacol 1981; 3: 1269–77
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet 2000; 356: 1255–9
Levine M, Walter S, Lee H, et al. Users’ guides to the medical literature. IV: how to use an article about harm. Evidence-Based Medicine Working Group. JAMA 1994 May 25; 271: 1615–9
Blachley JD, Hill JB. Renal and electrolyte disturbances associated with cisplatin. Ann Intern Med 1981; 95: 628–32
Gonzalez-Manzano R, Cid J, Brugarolas A, et al. Cyclosporin A and doxorubicin-ifosfamide in resistant solid tumours: a phase I and an immunological study. Br J Cancer 1995; 72: 1294–9
Hartmann JT, Kollmannsberger C, Kanz L, et al. Platinum organ toxicity and possible prevention in patients with testicular cancer. Int J Cancer 1999; 83: 866–9
Morgan Jr RJ, Braly P, Cecchi G, et al. Phase II trial of intraperitoneal cisplatin with intravenous doxorubicin and cyclophosphamide in previously untreated patients with advanced ovarian cancer-long-term follow-up. Gynecol Oncol 1999; 75: 419–26
Morgan Jr RJ, Braly P, Leong L, et al. Phase II trial of combination intraperitoneal cisplatin and 5 fluorouracil in previously treated patients with advanced ovarian cancer: long-term follow-up. Gynecol Oncol 2000; 77: 433–8
Ozols RF, Deisseroth AB, Javadpour N, et al. Treatment of poor prognosis nonseminomatous testicular cancer with a “high-dose” platinum combination chemotherapy regimen. Cancer 1983; 51: 1803–7
Park TK, Choi DH, Kim SN, et al. Role of induction chemotherapy in invasive cervical cancer. Gynecol Oncol 1991; 41: 107–12
Trump DL, Hortvet L. Etoposide and very high dose cisplatin: salvage therapy for patients with advanced germ cell neoplasms. Cancer Treat Rep 1985; 69: 259–61
Cruz JM, Peacock Jr JE, Loomer L, et al. Rapid intravenous infusion of amphotericin B: a pilot study. Am J Med 1992; 93: 123–30
Proleukin® drug information. Emeryville (CA): Chiron Corporation, 1992
Cancer Therapy Evaluation Program. Common Toxicity Criteria, Version 2.0. DCTD, NCI, NIH, DHHS. 1998 Mar
Bigby M. Rates of cutaneous reactions to drugs. Arch Dermatol 2001; 137: 765–70
De Ponti F, Poluzzi E, Montanaro N. Organising evidence on QT prolongation and occurrence of Torsades de Pointes with non-antiarrhythmic drugs: a call for consensus. Eur J Clin Pharmacol 2001; 57: 185–209
Wells PS, Holbrook AM, Croether NR, et al. Interactions of warfarin with drugs and food. Ann Intern Med 1994; 121: 676–83
Dukes MNG, Aronson JK, editors. Meyler’s side effect of drugs. 14th ed. Amsterdam: Elsevier, 2000
McEvoy GK, editor. AHFS drug information. Bethesda (MD): ASHP, 2002
Physicians’ desk reference. 56th ed. Montvale (NJ): Medical Economics Company Inc., 2002
Sweetman SC, editor. Martindale the complete drug reference. 33rd ed. London: Pharmaceutical Press, 2002
Holmes AM, Hesling CM, Wilson TM. Capreomycin-induced serum electrolyte abnormalities. Thorax 1970; 25: 608–11
Foster JE, Harpur ES, Garland HO. An investigation of the acute effect of gentamicin on the renal handling of electrolytes in the rat. J Pharmacol Exp Ther 1992; 261: 38–43
Garland HO, Birdsey TJ, Davidge CG, et al. Effects of gentamicin, neomycin and tobramycin on renal calcium and magnesium handling in two rat strains. Clin Exp Pharmacol Physiol 1994; 21: 109–15
Parsons PP, Garland HO, Harpur ES, et al. Acute gentamicin-induced hypercalciuria and hypermagnesiuria in the rat: dose-response relationship and role of renal tubular injury. Br J Pharmacol 1997; 122: 570–6
Schwartz JS, Kempa JS, Vasilomanolakis EC, et al. Viomycin-induced electrolyte abnormalities. Respiration 1980; 40: 284–92
Ambisome® product bibliograpy. Deerfield (IL): Fujisawa Healthcare, 1997
Barton CH, Pahl M, Vaziri ND, et al. Renal magnesium wasting associated with amphotericin B therapy. Am J Med 1984; 77: 471–4
Sabra R, Branch RA. Amphotericin B nephrotoxicity. Drug Saf 1990; 5: 94–108
Sharkey PK, Graybill JR, Johnson ES, et al. Amphotericin B lipid complex compared with amphotericin B in the treatment of cryptococcal meningitis in patients with AIDS. Clin Infect Dis 1996; 22: 315–21
Kozeny GA, Nicolas JD, Creekmore S, et al. Effects of interleukin-2 immunotherapy on renal function. J Clin Oncol 1988; 6: 1170–6
Proleukin®, aldesleukin product information. Emeryville (CA): Chiron Corporation, 2000
Sondel PM, Kohler PC, Hank JA, et al. Clinical and immunological effects of recombinant interleukin 2 given by repetitive weekly cycles to patients with cancer. Cancer Res 1988; 48: 2561–7
Lacy CF, Armstrong LL, Goldman MP, Lance LL, editors. Drug information handbook. 8th ed. Hudson (OH): Lexi-Comp Inc & American Pharmaceutical Association, 2000-2001: 35
Seymour JF. Induction of hypomagnesemia during Amsacrine treatment. Am J Hematol 1993; 42: 262–7
Trisenox®, arsenic trioxide product information. Seattle (WA): Cell Therapeutics, 2000
Rust DM, Soignet SL. Risk/benefit profile of arsenic trioxide. Oncologist 2001; 6Suppl. 2: 29–32
Unnikrishnan D, Dutcher JP, Varshneya N, et al. Torsades de pointes in 3 patients with leukemia treated with arsenic trioxide. Blood 2001; 97: 1514–6
Soignet SL, Frankel SR, Douer D, et al. United States multicenter study of arsenic trioxide in relapsed acute promyelocytic leukemia. J Clin Oncol 2001; 19: 3852–60
Paraplatin®, carboplatin product information. Princeton (NJ): Bristol-Myers Squibb, 2001
English MW, Skinner R, Pearson AD, et al. Dose-related nephrotoxicity of carboplatin in children. Br J Cancer 1999; 81: 336–41
Leyvraz S, Ohnuma T, Lassus M, et al. Phase 1 study of carboplatin in patients with advanced cancer, intermittent intravenous bolus, and 24-hour infusion. J Clin Oncol 1985; 3: 1385–92
Martinez JA, Martin G, Sanz GF, et al. A phase II clinical trial of carboplatin infusion in high-risk acute nonlymphoblastic leukemia. J Clin Oncol 1991; 9: 39–43
Ettinger LJ, Gaynon PS, Krailo MD, et al. A phase II study of carboplatin in children with recurrent or progressive solid tumors: a report from the Childrens Cancer Group. Cancer 1994; 73: 1297–301
Foster BJ, Clagett-Carr K, Leyland-Jones B, et al. Results of NCI-sponsored phase I trials with carboplatin. Cancer Treat Rev 1985; 12Suppl. A: 43–9
Gaynon PS, Ettinger LJ, Moel D, et al. Pediatric phase I trial of carboplatin: a Childrens Cancer Study Group report. Cancer Treat Rep 1987; 71: 1039–42
Baum ES, Gaynon P, Greenberg L, et al. Phase II trail cisplatin in refractory childhood cancer: Children’s Cancer Study Group Report. Cancer Treat Rep 1981; 65: 815–22
Bianchetti MG, Kanaka C, Ridolfi-Luthy A, et al. Persisting renotubular sequelae after cisplatin in children and adolescents. Am J Nephrol 1991; 11: 127–30
Bianchetti MG, Kanaka C, Ridolfi-Luthy A, et al. Chronic renal magnesium loss, hypocalciuria and mild hypokalaaemic metabolic alkalosis after cisplatin. Pediatr Nephrol 1990; 4: 219–22
Koch Nogueira PC, Hadj-Aissa A, Schell M, et al. Long-term nephrotoxicity of cisplatin, ifosfamide, and methotrexate in osteosarcoma. Pediatr Nephrol 1998; 12: 572–5
Markmann M, Rothman R, Reichman B, et al. Persistent hypomagnesemia following cisplatin chemotherapy in patients with ovarian cancer. J Cancer Res Clin Oncol 1991; 117: 89–90
Ozols RF, Corden BJ, Jacob J, et al. High-dose cisplatin in hypertonic saline. Ann Intern Med 1984; 100: 19–24
von der Weid NX, Erni BM, Mamie C, et al. Cisplatin therapy in childhood: renal follow up 3 years or more after treatment. Swiss Pediatric Oncology Group. Nephrol Dial Transplant 1999; 14: 1441–4
Denic S. Preoperative treatment of advanced skin carcinoma with cisplatin and bleomycin. Am J Clin Oncol 1999; 22: 32–4
Evans TRJ, Harper CL, Beveridge IG, et al. A randomised study to determine whether routine intravenous magnesium supplements are necessary in patients receiving cisplatin chemotherapy with continuous infusion 5-fluorouracil. Eur J Cancer 1995; 31A: 174–8
Giaccone G, Donadio M, Ferrati P, et al. Disorders of serum electrolytes and renal function in patients treated with cisplatinum on an outpatient basis. Eur J Cancer Clin Oncol 1985; 21: 433–7
Gorman DJ, Kefford R, Stuart-Harris R. Focal encephalopathy after cisplatin therapy [abstract]. Med J Aust 1989; 150: 399–401
Kibirige MS, Morris-Jones PH, Addison GM. Prevention of cisplatin-induced hypomagnesemia. Pediatr Hematol Oncol 1988; 5: 1–6
Bitran JD, Desser RK, Billings AA, et al. Acute nephrotoxicity following cis-dichlorodiammine-platinum. Cancer 1982; 49: 1784–8
Lammers PJ, White L, Ettinger LJ. Cis-platinum-induced renal sodium wasting. Med Pediatr Oncol 1984; 12: 343–6
Macaulay VM, Begent RH, Phillips ME, et al. Prophylaxis against hypomagnesaemia induced by cis-platinum combination chemotherapy. Cancer Chemother Pharmacol 1982; 9: 179–81
Brock PR, Koliouskas DE, Barratt TM, et al. Partial reversibility of cisplatin nephrotoxicity in children. J Pediatr 1991; 118: 531–4
Martin M, Diaz-Rubio E, Casado A, et al. Intravenous and oral magnesium supplementations in the prophylaxis of cisplatin-induced hypomagnesemia: results of a controlled trial. Am J Clin Oncol 1992; 15: 348–51
Mavichak V, Wong NL, Quamme GA, et al. Studies on the pathogenesis of cisplatin-induced hypomagnesemia in rats. Kidney Int 1985; 28: 914–21
Mune T, Yasuda K, Ishii M, et al. Tetany due to hypomagnesemia induced by cisplatin and doxorubicin treatment for synovial sarcoma. Intern Med 1993; 32: 434–7
Ortega JA, Krailo MD, Haas JE, et al. Effective treatment of unresectable or metastatic hepatoblastoma with cisplatin and continuous infusion doxorubicin chemotherapy: a report from the Childrens Cancer Study Group. J Clin Oncol 1991; 9: 2167–76
Brock PR, Yeomans EC, Bellman SC, et al. Cisplatin therapy in infants: short and long-term morbidity. Br J Cancer Suppl 1992; 18: S36–40
Piver MS, Lele SB, Patsner B, et al. 1.5-5 years of uninterrupted cis-diamminedichloroplatinum II chemotherapy for metastatic cervical cancer. Gynecol Oncol 1987; 27: 24–33
Planting AS, Catimel G, de Mulder PH, et al. Randomized study of a short course of weekly cisplatin with or without amifostine in advanced head and neck cancer. EORTC Head and Neck Cooperative Group. Ann Oncol 1999; 10: 693–700
Rosenthal CJ, Khulpateea N, Boyce J, et al. Effective chemotherapy for advanced carcinoma of the cervix with bleomycin, cisplatin, vincristine, and methotrexate. Cancer 1983; 52: 2025–30
Salem P, Khalyl M, Jabboury K, et al. Cis-diamminedichloroplatinum (II) by 5-day continuous infusion: a new dose schedule with minimal toxicity. Cancer 1984; 53: 837–40
Sartori S, Nielsen I, Tassinari D, et al. Changes in intracellular magnesium concentrations during cisplatin chemotherapy. Oncology 1993; 50: 230–4
Skinner R, Pearson AD, English MW, et al. Cisplatin dose rate as a risk factor for nephrotoxicity in children. Br J Cancer 1998; 77: 1677–82
Specht L, Larsen SK, Hansen HS. Phase II study of docetaxel and cisplatin in patients with recurrent or disseminated squamous-cell carcinoma of the head and neck. Ann Oncol 2000; 11: 845–9
Steffens TA, Bajorin DF, Chapman PB, et al. A phase II trial of high-dose cisplatin and dacarbazine: lack of efficacy of high-dose, cisplatin-based therapy for metastatic melanoma. Cancer 1991; 68: 1230–7
Tay HN, Yap HK, Murugasu B, et al. Adriamycin-induced cardiomyopathy aggravated by cis-platinum nephrotoxicity requiring dialysis [abstract]. J Singapore Paediatr Soc 1990; 32: 125–8
Vassal G, Rubie H, Kalifa C, et al. Hyponatremia and renal sodium wasting in patients receiving cisplatinum. Pediatr Hematol Oncol 1987; 4: 337–44
Davis S, Kessler W, Haddad BM, et al. Acute renal tubular dysfunction following cis-dichlorodiammine platinum therapy. J Med 1980; 11: 133–41
Wong NL, Mavichak V, Magil AB, et al. Sodium thiosulfate prevents cisplatin-induced hypomagnesemia. Nephron 1988; 50: 308–14
Zumkley H, Bertram HP, Preusser P, et al. Renal excretion of magnesium and trace elements during cisplatin treatment. Clin Nephrol 1982; 17: 254–7
Baselga J, Kris MG, Scher HI, et al. Phase II trial of gallium nitrate in previously treated patients with small cell lung cancer. Invest New Drugs 1993; 11: 85–6
Collery P, Millart H, Lamiable D, et al. Magnesium alterations and pharmacokinetic data in gallium-treated lung cancer patients. Magnesium 1989; 8: 56–64
Warrell Jr RP, Isaacs M, Coonley CJ, et al. Metabolic effects of gallium nitrate administered by prolonged infusion. Cancer Treat Rep 1985; 69: 653–5
Burnett RJ, Reents SB. Severe hypomagnesemia induced by pentamidine. DICP 1990; 24: 239–40
Orlee K, Stein-Gocken J. Torsade de pointes and elevated magnesium and calcium requirements associated with intravenous pentamidine. Nutr Clin Pract 1994; 9: 191–5
Pentacarinet™ data sheet. Auckland: Aventis Pharma Ltd., 2004 Mar
Matarese LE, Speerhas R, Seidner DL, et al. Foscarnet-induced electrolyte abnormalities in a bone marrow transplant patient receiving parenteral nutrition. JPEN J Parenter Enteral Nutr 2000; 24: 170–3
Guillaume MP, Karmali R, Bergmann P, et al. Unusual prolonged hypocalcemia due to foscarnet in a patient with AIDS. Clin Infect Dis 1997; 25: 932–3
Noormohamed FH, Youle MS, Tang B, et al. Foscarnet-induced changes in plasma concentrations of total and ionized calcium and magnesium in HIV-positive patients. Antivir Ther 1996; 1: 172–9
Palestine AG, Polis MA, De Smet MD, et al. A randomized, controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS. Ann Intern Med 1991; 115: 665–73
Jacobson MA, Gambertoglio JG, Aweeka FT, et al. Foscarnet-induced hypocalcemia and effects of foscarnet on calcium metabolism. J Clin Endocrinol Metab 1991; 72: 1130–5
Joborn H, Akerstrom G, Ljunghall S. Effects of exogenous catecholamines and exercise on plasma magnesium concentrations. Clin Endocrinol 1985; 23: 219–26
Joborn H, Hjemdahl P, Larsson PT, et al. Effects of prolonged adrenaline infusion and of mental stress on plasma minerals and parathyroid hormone. Clin Physiol 1990; 10: 37–53
Whyte KF, Addis GJ, Whitesmith R, et al. Adrenergic control of plasma magnesium in man. Clin Sci 1987; 72: 135–8
Ahrens RC, Smith GD. Albuterol: an adrenergic agent for use in the treatment of asthma pharmacology, pharmacokinetics and clinical use. Pharmacotherapy 1984; 4: 105–21
Lipworth BJ, Clark RA, Fraser CG, et al. The biochemical effects of high-dose inhaled salbutamol in patients with asthma. Eur J Clin Pharmacol 1989; 36: 357–60
Lipworth BJ, McDevitt DG, Struthers AD. Prior treatment with diuretic augments the hypokalaemic and electrocardiographic effects of inhaled albuterol. Am J Med 1989; 86: 653–7
Musch W, Vincken W, Noppen M, et al. Metabolic effects of inhaled fenoterol in normal subjects. Chest 1992; 102: 1099–103
Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988; 74: 595–7
Bremme K, Eneroth P, Nordstrom L, et al. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986; 5: 85–94
Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980; 9: 483–91
Hall TG, Schaiff RA. Update on the medical treatment of hypercalcemia of malignancy. Clin Pharm 1993; 12: 117–25
Nussbaum SR, Younger J, Vandepol CJ, et al. Single-dose intravenous therapy with pamidronate for the treatment of hypercalcemia of malignancy: comparison of 30-, 60-, and 90mg dosages. Am J Med 1993; 95: 297–304
Zometa®, zoledronic acid for injection prescribing information. Hanover (NJ): Novartis, 2003
Young G, Shende A. Use of pamidronate in the management of acute cancer-related hypercalcemia in children. Med Pediatr Oncol 1998; 30: 117–21
Sleeboom HP, Bijvoet OL, van Oosterom AT, et al. Comparison of intravenous (3-amino-1-hydroxypropylidene)-1, 1-bisphosphonate and volume repletion in tumour-induced hypercalcaemia. Lancet 1983; II: 239–43
Black HR. Metabolic considerations in the choice of therapy for the patient with hypertension. Am Heart J 1991; 121: 707–15
Taylor SH. Diuretic therapy in congestive heart failure. Cardiol Rev 2000; 8: 104–14
Greenberg A. Diuretic complications. Am J Med Sci 2000; 319: 10–24
Davies DL, Fraser R. Do diuretics cause magnesium deficiency? Br J Clin Pharmacol 1993; 36: 1–10
Pak CY. Correction of thiazide-induced hypomagnesemia by potassium-magnesium citrate from review of prior trials. Clin Nephrol 2000; 54: 271–5
Labeeuw M, Pozet N, Zech P, et al. Magnesuria induced by thiazides and the influence of triamterene. Fundam Clin Pharmacol 1987; 1: 225–32
Leary WP, Reyes AJ. Diuretic-induced magnesium losses. Drugs 1984; 28Suppl. 1: 182–7
Sotornik I, Schuck O. Effect of single dose of diuretics on renal magnesium excretion in man, with special reference to their site of action [abstract]. Physiol Bohemoslov 1976; 25: 207–12
Stefikova K, Spustova V, Dzurik R. Acute effect of hydrochlorothiazide on renal calcium and magnesium handling in postmenopausal women. Physiol Res 1999; 48: 327–30
Laerum E. Metabolic effects of thiazide versus placebo in patients under long-term treatment for recurrent urolithiasis. Scand J Urol Nephrol 1984; 18: 143–9
Martin BJ, Milligan K. Diuretic-associated hypomagnesemia in the elderly. Arch Intern Med 1987; 147: 1768–71
Salmela PI, Juustila H, Kinnunen O, et al. Comparison of low doses of hydrochlorothiazide plus amiloride and hydrochlorothiazide alone in hypertension in elderly patients. Ann Clin Res 1986; 18: 88–92
Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987; 147: 1553–6
Haenni A, Lind L, Lithell H. The blood pressure response to antihypertensive treatment with lisinopril or bendrofluazide is related to the calcium and magnesium contents in skeletal muscle. Am J Hypertens 1996; 9: 273–6
Frewin DB, Bartholomeusz RC, Gaffney RD, et al. A comparison of the effect of lisinopril and hydrochlorothiazide on electrolyte balance in essential hypertension. Eur J Clin Pharmacol 1992; 42: 487–90
Ljunghall S, Backman U, Danielson BG, et al. Calcium and magnesium metabolism during long-term treatment with thiazides. Scand J Urol Nephrol 1981; 1: 257–62
Lumme JA, Jounela AJ. Cardiac arrhythmias in hypertensive outpatients on various diuretics: correlation between incidence and serum potassium and magnesium levels. Ann Clin Res 1986; 18: 186–90
Ryan MP. Diuretics and potassium/magnesium depletion: directions for treatment. Am J Med 1987; 82: 38–47
Baumgart P. Torasemide in comparison with thiazides in the treatment of hypertension. Cardiovasc Drugs Ther 1993; 7Suppl. 1: 63–8
Nakahama H, Obata K, Sugita M, et al. Co-administration of furosemide augments tacrolimus-induced impairment in kidney function in rats. Ren Fail 2000; 22: 525–34
Ng LL, Garrido MC, Davies JE, et al. Intracellular free magnesium in lymphocytes from patients with congestive cardiac failure treated with loop diuretics with and without amiloride. Br J Clin Pharmacol 1992; 33: 329–32
Kuller L, Farrier N, Caggiula A, et al. Relationship of diuretic therapy and serum magnesium levels among participants in the Multiple Risk Factor Intervention Trial. Am J Epidemiol 1985; 122: 1045–59
Swales JD. Magnesium deficiency and diuretics. BMJ (Clin Red Ed) 1982; 285: 1377–8
Prisant LM, Beall SP, Nichoalds GE, et al. Biochemical, endocrine, and mineral effects of indapamide in black women. J Clin Pharmacol 1990; 30: 121–6
Campbell DB, Brackman F. Cardiovascular protective properties of indapamide. Am J Cardiol 1990; 65Suppl.: 11H–27H
Taylor DR, Constable J, Sonnekus M, et al. Effect of indapamide on serum and red cell cations, with and without magnesium supplementation, in subjects with mild hypertension. S Afr Med J 1988; 74: 273–6
Reyes AJ, Leary WP, Van der Byl K. Urinary magnesium output after a single dose of indapamide in healthy adults. S Afr Med J 1983; 64: 820–2
Gozzi T, Durler S, Truttman AC, et al. Free circulating magnesium and loop diuretics in humans. Eur J Clin Pharmacol 1997; 53: 275–6
Rabkin SW, Roob O. Effect of chronic diuretics on epinephrine-induced ventricular arrhythmias: a comparison of hydrochlorothiazide and amiloride in the rat. J Cardiovasc Pharmacol 1987; 10: 238–45
Kohvakka A, Salo H, Gordin A, et al. Antihypertensive and biochemical effects of different doses of hydrochlorothiazide alone or in combination with triamterene. Acta Med Scand 1986; 219: 381–6
Dyckner T, Wester PO. Renal excretion of electrolytes in patients on long-term diuretic therapy for arterial hypertension and/or congestive heart failure. Acta Med Scand 1985; 218: 443–8
Cocco G, Iselin HU, Strozzi C, et al. Magnesium depletion in patients on long-term chlorthalidone therapy for essential hypertension. Eur J Clin Pharmacol 1987; 32: 335–8
Borchgrevink PC, Holten T, Jynge P. Tissue electrolyte changes induced by high doses of diuretics in rats. Pharmacol Toxicol 1987; 60: 77–80
Wong NL, Sutton RA, Dirks JH. Is lymphocyte magnesium concentration a reflection of intracellular magnesium concentration? J Lab Clin Med 1988; 112: 721–6
Cohen N, Alon I, Almoznino-Sarafian D, et al. Metabolic and clinical effects of oral magnesium supplementation in furosemide-treated patients with severe congestive heart failure. Clin Cardiol 2000; 23: 433–6
Arthur JM, Shamim S. Interaction of cyclosporine and FK506 with diuretics in transplant patients. Kidney Int 2000; 58: 325–30
Burdmann EA, Andoh TF, Lindsley J, et al. Effects of oral magnesium supplementation on acute experimental cyclosporin nephrotoxicity. Nephrol Dial Transplant 1994; 9: 16–21
Adams DH, Ponsford S, Gunson B, et al. Neurological complications following liver transplantation. Lancet 1987; I: 949–51
Andoh TF, Burdmann EA, Fransechini N, et al. Comparison of acute rapamycin nephrotoxicity with cyclosporine and FK506. Kidney Int 1996; 50: 1110–7
Barton CH, Vaziri ND, Mina-Araghi S, et al. Effects of cyclosporine on magnesium metabolism in rats. J Lab Clin Med 1989; 114: 232–6
Bondesson L, Hammar H. Treatment of pemphigus vulgaris with cyclosporine. Dermatologica 1990; 181: 308–10
Clarke H, Ryan MP. Cyclosporine A-induced alterations in magnesium homeostasis in the rat. Life Sci 1999; 64: 1295–306
D’Haens G, Lemmens L, Geboes K, et al. Intravenous cyclosporine versus intravenous corticosteroids as single therapy for severe attacks of ulcerative colitis. Gastroenterology 2001; 120: 1323–9
Frost L, Danielsen H, Dorup I, et al. Skeletal muscle magnesium content during cyclosporin and azathioprine treatment in renal transplant recipients. Nephrol Dial Transplant 1993; 8: 79–83
List AF, Spier C, Greer J, et al. Phase I/II trial of cyclosporine as a chemotherapy-resistance modifier in acute leukemia. J Clin Oncol 1993; 11: 1652–60
Margreiter R. Efficacy and safety of tacrolimus compared with ciclosporin microemulsion in renal transplantation: a randomised multicentre study. Lancet 2002; 359: 741–6
Nozue T, Kobayashi A, Kodama T, et al. Pathogenesis of cyclosporine-induced hypomagnesemia. J Pediatr 1992; 120: 638–40
Ryffel B, Weber E, Mihatsch MJ. Nephrotoxicity of immunosuppressants in rats: comparison of macrolides with cyclosporin. Exp Nephrol 1994; 2: 324–33
Scoble JE, Freestone A, Varghese Z, et al. Cyclosporin-induced renal magnesium leak in renal transplant patients. Nephrol Dial Transplant 1990; 5: 812–5
Trompeter R, Filler G, Webb NJ, et al. Randomized trial of tacrolimus versus cyclosporin microemulsion in renal transplantation. Pediatr Nephrol 2002; 17: 141–9
Groth CG, Backman L, Morales JM, et al. Sirolimus (rapamycin)-based therapy in human renal transplantation: similar efficacy and different toxicity compared with cyclosporine. Sirolimus European Renal Transplant Study Group. Transplantation 1999; 67: 1036–42
Haag-Weber M, Schollmeyer P, Horl WH. Failure to detect remarkable hypomagnesemia in renal transplant recipients receiving ciclosporin. Miner Electrolyte Metab 1990; 16: 66–8
Kim HJ, Ahn YH, Kee CS, et al. Early short-term profile of serum magnesium concentration in living donor renal transplant recipients on cyclosporine. Transplant Proc 1994; 26: 2178–80
Morales JM, Wramner L, Kreis H, et al. Sirolimus does not exhibit nephrotoxicity compared to cyclosporine in renal transplant recipients. Am J Transplant 2002; 2: 436–42
Lote CJ, Thewles A, Wood JA, et al. The hypomagnesaaemic action of FK506: urinary excretion of magnesium and calcium and the role of parathyroid hormone. Clin Sci 2000; 99: 285–92
Ishioka M, Ohno S, Nakamura S, et al. FK506 treatment of noninfectious uveitis. Am J Ophthalmol 1994; 118: 723–9
Niederstadt C, Steinhoff J, Erbsloh-Moller B, et al. Effect of FK506 on magnesium homeostasis after renal transplantation. Transplant Proc 1997; 29: 3161–2
Prograf® product information. Deerfield (IL): Fujisawa Healthcare Inc., 2001 Jul
Taylor DO, Barr ML, Radovancevic B, et al. A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation: decreased hyperlipidemia and hypertension with tacrolimus. J Heart Lung Transplant 1999; 18: 336–45
Godson C, Ryan MP, Brady HR, et al. Acute hypomagnesaemia complicating the treatment of meconium ileus equivalent in cystic fibrosis. Scand J Gastroenterol Suppl 1988; 143: 148–50
Kinnunen O, Salokannel J. Comparison of the effects of magnesium hydroxide and a bulk laxative on lipids, carbohydrates, vitamins A and E, and minerals in geriatric hospital patients in the treatment of constipation. J Int Med Res 1989; 17: 442–54
Baker EH, Sandle GI. Complications of laxative abuse. Annu Rev Med 1996; 47: 127–34
Meyers AM, Feldman C, Sonnekus MI, et al. Chronic laxative abusers with pseudo-idiopathic oedema and autonomous pseudo-Bartter’s syndrome: a spectrum of metabolic madness, or new lights on an old disease? S Afr Med J 1990; 78: 631–6
Mitchell JE, Boutacoff LI, Hatsukami D, et al. Laxative abuse as a variant of bulimia. J Nerv Ment Dis 1986; 174: 174–6
Hirschel-Scholz S, Paunier L, Bonjour JP. Interference of WR-2721 with magnesium metabolism: mechanism of action. Miner Electrolyte Metab 1988; 14: 114–20
Hartmann JT, Fels LM, Knop S, et al. A randomized trial comparing the nephrotoxicity of cisplatin/ifosfamide-based combination chemotherapy with or without amifostine in patients with solid tumors. Invest New Drugs 2000; 18: 281–9
Kemp G, Rose P, Lurain J, et al. Amifostine pretreatment for protection against cyclophosphamide-induced and cisplatin-induced toxicities: results of a randomized control trial in patients with advanced ovarian cancer. J Clin Oncol 1996; 14: 2101–12
Ethyol® product information. West Conshohoken (PA): US Bioscience, 1999
Vannatta JB, Whang R, Papper S. Efficacy of intravenous phosphorus therapy in the severely hypophosphataemic patient. Arch Intern Med 1981; 141: 885–7
Backman U, Danielson BG, Johansson G, et al. Treatment of recurrent calcium stone formation with cellulose phosphate. J Urol 1980; 123: 9–13
Pak CY. Clinical pharmacology of sodium cellulose phosphate. J Clin Pharmacol 1979; 19: 451–7
Parfitt AM. Effect of cellulose phosphate and dietary calcium restriction in primary hyperparathyroidism. Clin Sci Mol Med 1975; 49: 91–8
Revusova V, Gratzlova J, Zvara V, et al. Sodium cellulose phosphate-induced increment in urinary calcium/magnesium ratio. Eur Urol 1975; 1: 294–6
Robertson NJ. Fatal overdose from a sustained-release theophylline preparation. Ann Emerg Med 1985; 14: 154–8
Knutsen R, Bohmer T, Falch J. Intravenous theophylline-induced excretion of calcium, magnesium and sodium in patients with recurrent asthmatic attacks. Scand J Clin Lab Invest 1994; 54: 119–25
Whang R. Clinical disorders of magnesium metabolism. Compr Ther 1997; 23: 168–73
Yu ASL. Disturbances in magnesium metabolism. In: Brenner BM, editor. Brenner and Rector’s The Kidney. 6th ed. Philadelphia (PA): WB Saunders Co, 2000: 1055–1070
Sutton RA, Walker VR, Halabe A, et al. Chronic hypomagnesemia caused by cisplatin: effect of calcitriol. J Lab Clin Med 1991; 117: 40–3
Wills MR. Magnesium and potassium: inter-relationships in cardiac disorders. Drugs 1986; 31Suppl. 4: 121–31
Hartmann O, Pinkerton CR, Philip T, et al. Very-high-dose cisplatin and etoposide in children with untreated advanced neuroblastoma. J Clin Oncol 1988; 6: 44–50
Vokes EE, Mick R, Vogelzang NJ, et al. A randomised study comparing intermittent to continuous administration of magnesium aspartate hydrochloride in cisplatin-induced hypomagnesaemia. Br J Cancer 1983; 62: 1015–7
Kirmani S, Lucas WE, Kim S, et al. A phase II trial of intraperitoneal cisplatin and etoposide as salvage treatment for minimal residual ovarian carcinoma. J Clin Oncol 1991; 9: 649–57
Markman M, Cleary S, Howell SB. Hypomagnesemia following high-dose intracavitary cisplatin with systemically administered sodium thiosulfate. Am J Clin Oncol 1986; 9: 440–3
Allegra A, Corica F, Ientile R, et al. Plasma (total and ionized), erythrocyte and platelet magnesium levels in renal transplant recipients during cyclosporine and/or azathioprine treatment. Magnes Res 1998; 11: 11–8
Reinhart RA, Broste SK, Spencer S, et al. Relation between magnesium and potassium concentrations in myocardium, skeletal muscle, and mononuclear blood cells. Clin Chem 1992; 38: 2444–8
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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
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Atsmon, J., Dolev, E. Drug-Induced Hypomagnesaemia. Drug-Safety 28, 763–788 (2005). https://doi.org/10.2165/00002018-200528090-00003
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DOI: https://doi.org/10.2165/00002018-200528090-00003