Low-dose cyclophosphamide-induced hyponatremia in primary breast cancer

Mizuno, Toshiro; Oda, Hiroyasu; Ishihara, Mikiya; Saito, Kanako; Yamashita, Yoshiki; Nakase, Kazunori

doi:10.15761/ccrr.1000491

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…Cyclophosphamide is a classic cytotoxic agent, and incidence of severe hyponatraemia with high-dose cyclophosphamide has been reported as 5.8% in a retrospective study 8. However, severe hyponatraemia with low-dose cyclophosphamide is a rare phenomenon, and one prospective observational study in patients with breast cancer from Japan reported an 18% incidence of all grades of hyponatraemia but 0% of severe hyponatraemia 9. Patients are sometimes also instructed to drink generous amounts of fluids to reduce the risk of cystitis with cyclophosphamide.…”

Section: Discussionmentioning

confidence: 99%

Severe hyponatraemia in two patients with breast cancer caused by low-dose cyclophosphamide and precipitated by aprepitant

2022

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Two postmenopausal women with breast cancer developed acute confusion and seizures, less than 24 hours after the first cycle of neoadjuvant chemotherapy with fluorouracil, epirubicin and low-dose cyclophosphamide. They were found to have severe, life-threatening hyponatraemia with sodium levels of 113 and 115 mEq/L, respectively. Both women made a full recovery within 24 hours of admission with slow correction of sodium levels. Following investigational workup, the most likely diagnosis was cyclophosphamide-associated syndrome of inappropriate antidiuretic hormone secretion (SIADH). Aprepitant - a commonly used antiemetic and moderate cytochromeP450 3A4 inhibitor was identified as the precipitating factor. Aprepitant was discontinued and both women were successfully re-challenged with full dose cyclophosphamide in an outpatient setting with no subsequent adverse events. This is a typical case of a rare cause of a common medical problem. A systematic approach to diagnosis and treatment of hyponatraemia in an oncology patient requires awareness of toxicities of systemic anticancer agents.

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Section: Discussionmentioning

confidence: 99%

Severe hyponatraemia in two patients with breast cancer caused by low-dose cyclophosphamide and precipitated by aprepitant

2022

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Drugs associated with drug-induced hyponatremia

Листратов

Komarova

Aleshckovich

et al. 2021

Medicinskij alfavit

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Hyponatremia (HN) is a significant disturbance of the water-electrolyte balance in clinical practice. Drugs are one of the leading causes of low sodium level. Antidepressants, antiepileptic, antipsychotic, antineoplastic drugs and opioid analgesics are the most common medications that induce hyponatremia. Special attention should be paid to people with cancer, who often receive several drugs that induce HN. Risk factors for the development of drug-induced (DI) HN when taking most medications are female sex, weight loss, and old age. In persons receiving therapy with the listed drugs, it is necessary to assess the risk factors for a decrease in the sodium level, clinical manifestations from the nervous system, and to determine the sodium level in dynamics. Special care must be taken when treating elderly patients, since they have several risk factors for the development of DI HN. These measures will help prevent the development of HN and its severe and sometimes fatal complications.

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Drug-Drug Interactions in Patients with Breast Cancer

Gudapati,

Oroszi

2024

JBM

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Low-dose cyclophosphamide-induced hyponatremia in primary breast cancer

Cited by 3 publications

References 12 publications

Severe hyponatraemia in two patients with breast cancer caused by low-dose cyclophosphamide and precipitated by aprepitant

Severe hyponatraemia in two patients with breast cancer caused by low-dose cyclophosphamide and precipitated by aprepitant

Drugs associated with drug-induced hyponatremia

Drug-Drug Interactions in Patients with Breast Cancer

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