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Drug Safety

, Volume 40, Issue 5, pp 373–386 | Cite as

Anti-Angiogenic Tyrosine Kinase Inhibitors and Reversible Posterior Leukoencephalopathy Syndrome: Could Hypomagnesaemia Be the Trigger?

  • Rashmi R. Shah
Review Article

Abstract

Reversible posterior leukoencephalopathy syndrome (RPLS), also known frequently as posterior reversible encephalopathy syndrome (PRES), is a characteristic acute neuro-radiology syndrome with clinical presentation that typically includes acute hypertension, seizures and other neurological symptoms and signs. Many patients with RPLS have (a history of) pre-existing hypertension and in receipt of diuretics. It is being diagnosed more frequently and in association with an increasing number of morbidities and medications. Drugs most frequently implicated are immunosuppressant drugs and anticancer agents, including a number of anti-angiogenic tyrosine kinase inhibitors (TKIs). Hypomagnesaemia is a frequent finding at presentation in RPLS patients, which is known to lead to or aggravate hypertension. Pre-eclampsia, a variant of RPLS, responds effectively to intravenous magnesium. Cyclosporin, tacrolimus and some TKIs that induce RPLS are also known to give rise to both hypertension and hypomagnesaemia. This raises an interesting hypothesis that hypomagnesaemia may play a contributory role in triggering RPLS in some patients by acutely raising the blood pressure further. Additional systematic studies are required to test this hypothesis. If the hypothesis is confirmed, hypomagnesaemia offers an effective target for risk mitigation and prevention of RPLS in patients identified at risk.

Keywords

Sorafenib Sunitinib Vascular Endothelial Growth Factor Receptor Pazopanib Vemurafenib 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with Ethical Standards

This is a review of data in the public domain and Dr. Shah declares compliance with all ethical standards.

Funding

No sources of funding were used to assist in the preparation of this review.

Conflict of interest

Dr. Rashmi Shah has no conflicts of interest that are relevant to the content of this review and did not receive any financial support for writing it. He was formerly a Senior Clinical Assessor at the Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK. He now provides expert consultancy services concerning the development and safety of drugs to a number of pharmaceutical companies.

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© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Pharmaceutical ConsultantBuckinghamshireUK

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