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Amphotericin B

    Brands

    amphotericin B deoxycholate (Rx)

    Brand and Other Names: amphotericin B (conventional)
    • Classes: Antifungals, Systemic

    amphotericin B cholesteryl sulfate (Rx)

    Brand and Other Names: Amphotec
    • Classes: Antifungals, Systemic

    amphotericin B phospholipid complex (Rx)

    Brand and Other Names: Abelcet
    • Classes: Antifungals, Systemic

    amphotericin B liposomal (Rx)

    Brand and Other Names: AmBisome
    • Classes: Antifungals, Systemic

    Polyene antifungal antibiotic similar to nystatin; despite many well-known systemic side effects and toxicities, IV amphotericin B remains the drug of choice for many serious systemic fungal infections; available as an injection, oral suspension, or in topical formulations.

    One of 3 lipid-based IV amphotericin B formulations; increases tolerability (e.g., decrease nephrotoxicity); similar spectrum of activity and efficacy as conventional amphotericin B.

    Indicated for treatment of invasive aspergillosis in patients where renal impairment or unacceptable toxicity precludes the use of amphotericin B deoxycholate (conventional) in effective doses, or where prior amphotericin B deoxycholate therapy has failed

    Indicated for invasive fungal infection refractory to conventional amphotericin B desoxycholate therapy or when renal impairment or unacceptable toxicity precludes use conventional amphotericin B

    Indicated for empiric therapy for presumed fungal infection in febrile, neutropenic patients

    Hypersensitivity

    • Chills (50-77%)
    • Fever (33-55%)
    • Hypokalemia (7-26%)
    • Elevated serum creatinine (12-21%)
    • Hyperbilirubinemia (2-19%)
    • Hypotension (9-12%)
    • Tachycardia (9-12%)
    • Nausea (8-12%)
    • Vomiting (6-11%)
    • Abnormal LFTs (4-11%)
    • Hypertension (7-9%)
    • Hypoxia (5-9%)
    • Dyspnea (4-9%)
    • Headache (4-8%)
    • Hypomagnesemia (4-7%)
    • Increased alkaline phosphatase (3-7%)
    • Thrombocytopenia (1-7%)
    • Hyperglycemia (1-6%)

    Indicated for patients with progressive and potentially fatal fungal infections

    Do not use for noninvasive fungal infections (eg, oral thrush, vaginal candidiasis, esophageal candidiasis) in patients with normal neurophil counts

    Caution when coadministration with other drugs that cause hypokalemia (eg, corticosteroids, digoxin)

    Caution with other nephrotoxic medications

    Indicated for patients with progressive and potentially fatal fungal infections

    Do not use for noninvasive fungal infections (eg, oral thrush, vaginal candidiasis, esophageal candidiasis) in patients with normal neurophil counts

    Pregnancy Category: B

    Lactation: Unknown whether distributed in breast milk, caution advised

    Maximum dosage is generally dependent on route of administration and the indication for use. General IV maximum dosage guidelines follow.

    Adults

    1—1.5 mg/kg/day IV.

    Elderly

    1—1.5 mg/kg/day IV.

    Adolescents

    1—1.5 mg/kg/day IV.

    Children

    Generally 1 mg/kg/day IV; occasional short term use of 1.5 mg/kg/day IV may be permissible in specific situations.

    Amphotericin B

    powder for injection

    • 50mg/vial
    • 100mg/vial

    injectable, lipid complex

    • 5mg/mL