بررسی شیوع عوارض جانبی و ریسک فاکتور های نفروتوکسیسیته به دنبال مصرف آمفوتریسین ب در افراد تحت شیمی درمانی

Abstract

Drugs used for prevention and treatment of cancer typically have cytotoxic and inhibitory effects on bone marrow. These effects are common in hemopoietic cancers which affect the bone marrow and drug regimens to treat this type of cancer mainly includes several medicines with simultaneous inhibitory effects on bone marrow. Subsequent to the inhibition of bone marrow cells, a decreased production of defense cells occur and therefore reduced body's ability to fight pathogens will happen. Presence of infection in the body is usually associated with fever and the fever due to bone marrow suppression is called febrile neutropenia. One of the most important drugs in treatment of febrile neutropenia is amphotericin B. This medicine has some immediate side effects such as hypothermia, hyperthermia, hypotension, hypertension, nausea, diarrhea, muscular and joint pain, irritability and etc. There are also a series of side effects related to the toxicity of this drug such as liver disorders, peripheral neuropathy, nephrotoxicity, anemia and increased renal potassium excretion that causes hypokalemia and hypomagnesiuma. The aim of the present study was to examine prevalence of side effects amphotericin B in patients with neutropenic fever. In this study, 100 patients from hospitalized in Shahid Ghazi hospital in Tabriz, who were on amphotericin B, were examined. A questionnaire was designed in four sections. The questionnaires were completed using the information in patients records and direct questions from patients. The data was analyzed using SPSS and Excel softwares.The results of this study showed that a total of 44% of the subjects were female and 56% patients were male. hundred patients treated with amphotericin B, suffered a series of side effects. The most common side effects included fever (83%), headache (79%), myalgia (60%), dizziness (57%), state restlessness (54%), joint pain (52%), diarrhea (46%).It was observed that with increase in cumulative dose of amphotericin B a rise in serum creatinine and urea concentration happened which was an indication of nephrotoxicity. Treatment duration and cumulative dose of amphotericin B had no significant effects on serum potassium and sodium concentrations and blood cell count.One of the most important side effects of amphotericin B that restricts its usage is its nephrotoxicity. There are several methods that can be employed to reduce nephrotoxicity of amphotericin B. Liposomal formulation of amphotericin B has the lowest nephrotoxicity. In Iran non-lipid form of amphotericin is used routinely and therefore in order to reduce nephrotoxicity, it is recommended to use other formulations of amphotericin B. There are also other methods that can be employed for reducing amphotericin B nephrotoxicity. Examples of such a recommended methods are reduction in infusion rate and administration sodium, potassium and magnesium salts prior to amphotericin B adminstration.