• IV: Treatment of progressive, potentially fatal fungal infections. The lipid complex, and liposome formulations should be considered for patients who are intolerant (e.g., renal dysfunction) or refractory to amphotericin B deoxycholate.

Amphotericin B liposome:

• Management of suspected fungal infections in febrile neutropenic patients:
  • Treatment of visceral leishmaniasis,
  • Treatment of cryptococcal meningitis in HIV patients.

Contraindicated in:

• Hypersensitivity
• Lactation: Potential for distribution into breast milk and toxicity in infant; discontinue nursing.

Use Cautiously in:

• Renal impairment or electrolyte abnormalities
• Patients receiving concurrent leukocyte transfusions (↑ risk of pulmonary toxicity)
• OB: Has been used safely.

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.

Drug-Drug:

• ↑ risk of nephrotoxicity, bronchospasm, and hypotension with antineoplastics.
• Concurrent use with corticosteroids ↑ risk of hypokalemia.
• Concurrent use with zidovudine may ↑ the risk of myelotoxicity and nephrotoxicity.
• Concurrent use with flucytosine ↑ antifungal activity but may ↑ the risk of toxicity from flucytosine.
• Combined use with azole antifungals may induce fungal resistance.
• ↑ risk of nephrotoxicity with other nephrotoxic agents such as aminoglycosides, cyclosporine, or tacrolimus.
• Hypokalemia from amphotericin ↑ the risk of digoxin toxicity.
• Hypokalemia may enhance the curariform effects of neuromuscular blocking agents.

(Generic available)

Amphotericin Deoxycholate

• Powder for injection: 50 mg/vial;

Amphotericin B Lipid Complex

• Suspension for injection: 5 mg/mL;

Amphotericin B Liposome

• Powder for injection: 50 mg/vial;

Amphotericin Deoxycholate

• IV (Adults): Give test dose of 1 mg. If test dose tolerated, initiate therapy with 0.25 mg/kg/day (doses up to 1.5 mg/kg/day may be used, depending on type of infection) (alternate-day dosing may also be used); Bladder irrigation: Instill 50 mcg/mL solution into bladder daily for 5–10 days.
• IV (Infants and Children): Give test dose of 0.1 mg/kg (maximum dose 1 mg) or may administer initial dose of 0.25–1 mg/kg/day over 6 hr (without test dose) (some infections may require 1.5 mg/kg/day; alternate-day dosing may be used).
• IT (Adults): 25–300 mcg every 48–72 hr, ↑ to 500 mcg–1 mg as tolerated (maximum total dose = 15 mg).
• IT (Children): 25–100 mcg every 48–72 hr; ↑ to 500 mcg as tolerated.

Amphotericin B Lipid Complex (Abelcet)

• IV (Adults and Children): 2.5–5 mg/kg every 24 hr (no test dose needed).

Amphotericin B Liposome (AmBisome)

• IV (Adults and Children): Empiric therapy: 3 mg/kg every 24 hr; Documented infections: 3–5 mg/kg every 24 hr; Visceral leishmaniasis (immunocompetent patients): 3 mg/kg every 24 hr on days 1–5, then 3 mg/kg every 24 hr on days 14 and 21; Visceral leishmaniasis (immunosuppressed patients): 4 mg/kg every 24 hr on days 1–5, then 4 mg/kg every 24 hr on days 10, 17, 24, 31, and 38; Cryptococcal meningitis in HIV patients: 6 mg/kg every 24 hr.

amphotericin B lipid complex: Abelcet

amphotericin B liposome: AmBisome

• Binds to fungal cell membrane, allowing leakage of cellular contents.
• Toxicity (especially acute infusion reactions and nephrotoxicity) is less with lipid formulations.

• Can be fungistatic or fungicidal (depends on concentration achieved and susceptibility of organism).

Spectrum:

• Active against:
  • Aspergillosis,
  • Blastomycosis,
  • Candidiasis,
  • Coccidioidomycosis,
  • Cryptococcosis,
  • Histoplasmosis,
  • Leishmaniasis (liposomal formulation only),
  • Mucormycosis.

Therapeutic Classification: antifungals

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.

amphotericin B deoxycholate: Fungizone

(blood levels)

• Explain need for long duration of IV therapy.
• Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breast feeding during therapy.
• IV: Inform patient of potential side effects and discomfort at IV site. Advise patient to notify health care professional if side effects occur.
• Home Care Issue: Instruct family or caregiver on dilution, rate, and administration of drug and proper care of IV equipment.

am-foe-TER-i-sin bee

NDC Code^*

• 0469- Astellas Pharma US, Inc.
  • 0469-3051- AmBisome
    • 0469-3051-30- 12.5 mL in 1 VIAL, SINGLE-DOSE (0469-3051-30)

• 39822- X-GEN Pharmaceuticals, Inc.
  • 39822-1055- Amphotericin B
    • 39822-1055-5- 10 mL in 1 VIAL (39822-1055-5)