Amphotericin - Lipid Associated

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Dosing

Adult

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

Discuss dosing as well as premedication with pharmacy.

General Information

Common Usage

Fungicidal therapy of yeast/fungus/mold infection.

Invasive candidiasis, aspergillosis, cryptococcosis.

Visceral/mucocutaneous Leishmaniasis.

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

Not for use in urinary tract infection.

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.

  •  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

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

Premedication with acetaminophen, diphenhydramine, or hydrocortisone are used. Meperidine may be used for rigors.

Pay 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.

Pregnancy category: B

Average serum half life: 150 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor