Antimicrobials
Amphotericin - Liposomal

Amphotericin - Liposomal

Low
N/A
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status Yes (parenteral inj)

In-Hospital Cost will be updated

PharmaCare Formulary Status No

Special Authority None

PharmaCare Coverage None

Outpatient Cost 50mg powder for soln - $130.68-143.75/vial

Fungicidal therapy of yeast/fungus/mold infection (not for use in urinary tract infection).

Invasive candidiasis, aspergillosis, cryptococcosis.

Visceral/mucocutaneous Leishmaniasis.

Induction therapy for dimorphic fungii (cocci, blasto, histo).

  • Renal function
  • K
  • Mg
  • HCO3
  • Liver enzymes
  • CBC

Frequency depends on course, but daily reasonable during initiation

Careful attention to electrolyte and fluid status with boluses (usually 500ml) of NS before and after infusion

Same toxicities as conventional Amphotericin B but with less frequency

Nephrotoxicity (IV)

  • reversible and often transient decline in GFR
  • increase in SCr above baseline
  • less nephrotoxic than conventional and lipid complex formulations
  • to ameliorate GFR decline: volume expansion with 500ml of 0.9% IV sodium chloride before infusion or divided before and after

Infusion-related reactions (IV)

  • sx: fever, headache, nausea, vomiting, chills and rigors
  • usually occurs within 15 mins to 3 hrs following initiation or immediately following administration
  • treatment: acetaminophen (fever), diphenhydramine or promethazine or prochlorperazine or ondansetron (nausea and vomiting), meperidine (chills and rigors), ibuprofen (chills)

Phlebitis (IV)

  • complication of infusions via a small peripheral vein
  • can be minimized by infusion using a central line, use of alternating infusion sites, avoiding concentrations >0.1mg/ml and avoiding infusion times < 4 hrs

Electrolyte abnormalities (IV)

  • hypoK, hypoMg and hyperchloremic acidosis (loss of bicarb)
  • caused by increase in distal tubular membrane permeability
  • treatment: K and Mg supplementation PRN

Anemia (IV)

  • reversible, normochromic, normocytic anemia
  • onset may be delayed for as long as 10 weeks after initiation

Main concern is concomitant nephrotoxins - use should be minimized during amphotericin therapy

Digoxin - increased digoxin toxicity with hypokalemia

Antimicrobial class: Antifungal, Polyene - Lipid Formulation (designed to minimize toxicity)

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

Average serum half life: 150.0 hr

Urine penetration: Poor

Lung penetration: Therapeutic

Biliary penetration: Therapeutic