Amphotericin - Lipid Associated

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$$$$

Dosing

Adult

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

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

Discuss with dosing and premedication with Pharmacy

Restricted Use

Restricted to use by Adult or Pediatric Infectious Diseases Service approval.

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

Laboratory

  • Twice-weekly Cr, K, Mg

  • Weekly LFTs and CBC

Clinical

  • Infusion-related effects

Adverse Effects

  • Lower incidence of nephrotoxicity than amphotericin B deoxycholate

  • Infusion-related effects

  • Electrolyte disturbances (hypokalemia, magnesemia)

Major Interactions

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

Digoxin - 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.

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 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor