Amphotericin B deoxycholate

C difficile risk
Low
Oral Bioavailability
N/A

Dosing

0.3 - 1.5 mg/kg IV daily.

Note: Lipid-based and conventional formulations are not interchangeable and have different dosage recommendations. Overdoses have occurred when conventional formulations were dispensed inadvertently for lipid-based products.

Initial: 1 mg/kg/dose IV Q24H. May increase dose to maximum of 1.5 mg/kg/dose IV Q24H if clinically indicated

a. Dilute in D5W or D10W ONLY!
b. Maximum recommended concentration for peripheral infusion is 0.1 mg/mL. In fluid restricted patients or for central line administration may increase to 0.2 mg/mL

Daily Dose to be infused over 2 - 6 hours

IV

Peripheral LineCentral Lines0.1 mg/mL0.2 mg/mL

To Prepare 0.1 mg/mL SolutionTo Prepare 0.2 mg/mL SolutionReconstitute 50 mg vial with 10 mL of Sterile water for injection = 5 mg/mLMix 29.4 mL of D5W, D10W, or D20W with 0.6 mL of 5 mg/mL concentration in a 30 mL empty sterile vialMix 28.8 mL of D5W, D10W, or D20W with 1.2 mL of 5 mg/mL concentration in a 30 mL empty sterile vial

5 mg/mL = 7 days
0.1 mg/mL = 24H
0.2 mg/mL = 24H
Refrigerate

Note dosage adjustment is not required for patients with pre existing renal dysfunction, however, if renal dysfunction is due to amphotericin, the daily total can be decreased by 50% or the dose can be given every other day.

General Information

  • Consultation with infectious disease specialist recommended.

  • Fungicidal therapy of yeast/fungus/mold infection.

  • Lipid formulations of amphotericin B are usually preferred over deoxycholate to minimize toxicity (except in the setting of urinary tract infections).

Pregnancy:

  • Considered compatible with all stages of pregnancy, including the first trimester.

  • Amphotericin B has not been associated with any congenital malformations or other untoward outcomes.

Breastfeeding:

  • No data.

  • Amphotericin B is not absorbed orally.

  • PK properties make transfer into milk unlikely (large molecular weight, highly protein bound).

Renal function, K, Mg, HCO3, liver enzymes, CBC.

Frequency depends on course, but daily reasonable during initiation.

  • Infusion related symptoms: fever/rigors/nausea/vomiting/headache (see additional information), phlebitis

  • Electrolyte abnormalities - hypoK and hypoMg, loss of bicarb (see additional information)

  • Nephrotoxicity ++ (see additional information)

  • Anemia

  • Concomitant nephrotoxins - use should be minimized during amphotericin therapy

  • Digoxin - increased digoxin toxicity with hypokalemia

Adequate hydration prior to infusion is recommended to reduce risk of nephrotoxicity.

  • K and Mg supplementation may be required.

Premedication with analgesics, antiemetics, antihistamines and hydrocortisone may be required for infusion related reactions.

If renal dysfunction is due to amphotericin, the daily total can be decreased by 50% or the dose can be given every other day.

Antimicrobial class: Antifungal - polyene