Amphotericin - lipid associated

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Dosing

Ambisome - 3-6mg/kg IV daily infused over several hours Abelcet - 5mg/kg IV daily infused over several hours

General Information

Common Usage

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)

Drug Monitoring

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

Frequency depends on course, but daily reasonable during initiation

Adverse Effects

Same toxicities as conventional Amphotericin B but with less frequency

Infusion related symptoms: fever/rigors/N/V/headache (see additional information)

Electrolyte abnormalities - hypoK and hypoMg, loss of bicarb (see additional information re: electrolyte infusions)

Nephrotoxicity ++

Anemia

Phlebitis

Urinary retention

Paresthesias

Major Interactions

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

Digoxin - increased digoxin toxicity with hypokalemia

Additional Information

Must be approved by Infectious Disease.

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

Careful attention to electrolyte and fluid status with boluses (usually 500mL) before and after infusion, as well as K and Mg supplementation PRN

Pharmacology

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

Average serum half life: 150.0

Urine penetration: Poor

Lung penetration: Therapeutic

Biliary penetration: Therapeutic