Amphotericin B Deoxycholate

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Dosing

  • For patients who experience infusion-related reactions, premedicate 30 to 60 mintures before with an NSAID and/or diphenhydramine, or hydrocortisone.

Fungizone - 0.3-1.5mg/kg IV daily, infused over several hours.

Dose adjustment is unnecessary for pre-existing renal dysfunction however, decreased renal function caused by amphotericin may warrent a dose adjustment (e.g. a 50% reduction of the total daily dose or dosing every 48 hr)

General Information

Common Usage

Treatment of patients with progressive, potentially life-threatening fungal infections: Aspergillosis, cryptococcosis (torulosis), North American blastomycosis, systemic candidiasis, coccidioidomycosis, histoplasmosis, zygomycosis (including mucormycosis due to susceptible species of the genera Absidia, Mucor, and Rhizopus), and infections due to related susceptible species of Conidiobolus, Basidiobolus, and sporotrichosis.

Drug Monitoring

Laboratory

  • Every 48 hr when treatment initiated - SCr, BUN, K, Mg

  • Weekly - Liver enzymes, CBC

Clinical

  • Infusion related reaction

Adverse Effects

  •  Nephrotoxicity ++

  •  Anemia

  •  Phlebitis

  •  Arachnoiditis

  •  Urinary retention

  •  Paresthesias

Infusion related symptoms

  •  Fever

  •  Rigors

  •  N/V

  •  Headache

Electrolyte abnormalities -

  •  HypoK and HypoMg

  •  Loss of bicarb

  •  See "Additional Information"

Major Interactions

Main concern is concomitant nephrotoxins. Use should be minimized during amphotericin therapy.

Increased digoxin toxicity with hypokalemia.

Additional Information

Premedication with NSAIDs, diphenhydramine or hydrocortisone are used.

Meperidine may be used for rigors.

Pay careful attention to electrolyte and fluid status with boluses (usually 500mL) of NS before and after infusion, as well as K and Mg supplementation PRN.

Pharmacology

Antimicrobial class: Antifungal. Polyene

Pregnancy category: B

Average serum half life: 24 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Therapeutic