section name header

Pronunciation

am-foe-TER-i-sin bee

Classifications

Therapeutic Classification: antifungals

Indications

High Alert


Amphotericin B liposome

Action

  • Binds to fungal cell membrane, allowing leakage of cellular contents.
  • Toxicity (especially acute infusion reactions and nephrotoxicity) is less with lipid formulations.
Therapeutic effects:
  • Can be fungistatic or fungicidal (depends on concentration achieved and susceptibility of organism).

Spectrum:

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Extensively distributed to body tissues and fluids. Poor penetration into CSF.

Metabolism/Excretion: Elimination is very prolonged. Detectable in urine up to 7 wk after discontinuation.

Half-Life: Biphasic—initial phase, 24–48 hr; terminal phase, 15 days. Lipid complex: 174 hr. Liposomal: 100–153 hr.

Time/Action Profile

(blood levels)

ROUTEONSETPEAKDURATION
IVrapidend of infusion24 hr





Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: chest pain, hypotension, edema, hypertension, tachycardia

Derm: pruritus, rashes

F and E: hyperglycemia, hypocalcemia, hypokalemia, hypomagnesemia

GI: liver enzymes, diarrhea, hyperbilirubinemia, nausea, vomiting, abdominal pain

GU: nephrotoxicity, hematuria

Hemat: anemia, leukopenia, thrombocytopenia

Local: phlebitis

MS: arthralgia, myalgia

Neuro: anxiety, confusion, headache, insomnia

Resp: dyspnea, hypoxia, wheezing

Misc: chills, fever, acute infusion reactions, HYPERSENSITIVITY REACTIONS

Interactions

Drug-drug:

Route/Dosage

Amphotericin Deoxycholate

Amphotericin B Lipid Complex (Abelcet)

Amphotericin B Liposome (AmBisome)

Availability

(Generic available)

Amphotericin Deoxycholate

Amphotericin B Lipid Complex

Amphotericin B Liposome

Assessment

Lab Test Considerations:

Implementation

Shake vial gently until yellow sediment at bottom has dissolved. Withdraw dose from required number of vials with 18-gauge needle. Replace needle from syringe filled with amphotericin B lipid complex with 5-micron filter needle. Each filter needle may be used to filter the contents of no more than 4 vials. Insert filter needle of syringe into IV bag of D5W and empty contents of syringe into bag. Protect from light. Infusion is stable for 6 hr at room temperature or 48 hr if refrigerated.Final concentration of infusion should be 1 mg/mL; a concentration of 2 mg/mL can be used for pediatric patients or patients who cannot tolerate large volumes of fluid.

Do not use an in-line filter. Infuse at a rate of 2.5 mg/kg/hr via infusion pump. If infusion exceeds 2 hr, mix contents by shaking infusion bag every 2 hr. If administering through an existing line, flush line with D5W before infusion or use a separate line.

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

amphotericin B lipid complex: Abelcet,

amphotericin B liposome: AmBisome

Canadian Brand Names

amphotericin B deoxycholate: Fungizone