Amphotericin - lipid associated

C difficile risk
Low
Oral Bioavailability
N/A

Dosing

Amphotericin B liposomal (Ambisome)Ampheriticin B lipid complex (Abelcet)Note3 - 6 mg/kg IV daily
5 mg/kg IV dailyLipid-based and conventional (deoxycholate) formulations are not interchangeable and have different dosing recommendations. Overdoses have occurred when conventional formulations were dispensed inadvertently for lipid-based products.

General Information

Fungicidal therapy of yeast/fungus/mold infection (not for use in 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

  • Same toxicities as conventional amphotericin B but with less frequency.

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

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

  • Nephrotoxicity ++

  • Anemia

Concomitant nephrotoxins - use should be minimized during amphotericin therapy

Digoxin - increased digoxin toxicity with hypokalemia

Lipid associated AmB is taken up preferentially by phagocytic cells and concentrated at sites of infection while minimizing renal exposure.

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. These reactions are usually more common with the first few doses and generally diminish with subsequent doses.

Antimicrobial class: Antifungal - polyene - Lipid formulations (designed to minimize toxicity)