Amphotericin B Deoxycholate

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Dosing

Adult

0.3-1.5 mg/kg IV Daily
Discuss indication-specific dosing with Pharmacy/ID.
Lipid formulation or azole therapy may be preferred.

Hepatic

No adjustment required

General Information

Common Usage

Fungicidal therapy of yeast/fungus/mold infection, especially of the urinary tract as lipid formulations are otherwise preferred to minimize toxicity.

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

  •  Nephrotoxicity ++

  •  Hypotension

  •  Tachycardia

  •  Tachypnea

  •  CNS effects: headache, malaise, pain, delirium, paresthesias, arachnoiditis, neuralgias

  •  GI disturbances: anorexia, diarrhea, nausea heartburn

  •  Anemia

  •  Urinary retention

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 acetaminophen, 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

CSF penetration: Therapeutic with appropriate dosing but otherwise low. Remains effective for Cryptococcus.

Lung penetration: Therapeutic

Urine penetration: Therapeutic