Which of the following antifungal agents can cause hypokalemia as a side effect?

Amphotericin B is known to cause hypokalemia as a side effect largely due to its mechanism of action and its effects on renal physiology. This antifungal agent is a polyene that binds to ergosterol in the fungal cell membrane, leading to cell lysis. However, its interactions with cellular membranes can also affect human cells, particularly in the kidneys.

The primary mechanism through which amphotericin B induces hypokalemia is through the inhibition of renal tubular function. Specifically, it can cause damage to the distal nephron, leading to increased potassium secretion and ultimately resulting in a drop in serum potassium levels. This side effect is clinically significant and warrants monitoring potassium levels in patients receiving amphotericin B.

This side effect distinguishes it from other antifungal agents mentioned. Fluconazole and voriconazole, for instance, primarily act as azole antifungals that inhibit the enzyme lanosterol 14α-demethylase in the ergosterol synthesis pathway, and they do not have the same renal toxicity profile that leads to hypokalemia. Caspofungin, which belongs to the echinocandin class, works by inhibiting the synthesis of β(1,3)-D-glucan in the fungal cell wall