Amphotericin - lipid associated

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$500+/day

Spectrum Of Activity

Dosing

Lipid Complex (Abelcet): IV 2 to 5mg/kg/DAY given as a single daily dose.

Liposomal (Ambisome): IV: 3 to 5mg/kg/DAY given as a single daily dose.

Lipid Complex (Abelcet): IV: 2.5 to 5 mg/kg/DAY given as a single daily dose.

Liposomal (Ambisome): IV: 3 to 5mg/kg/DAY given as a single daily dose

Contact pharmacy for more information regarding use in renal impairment.

General Information

Common Usage

Fungicidal therapy of yeast/fungus/mold infection (not for use in urinary tract infection)

Invasive candidiasis, aspergillosis, cryptococcosis <br>Visceral/mucocutaneous Leishmaniasis

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

Drug Monitoring

Renal function, fluid status, serum electrolytes (K, Mg). <br>Liver enzymes, CBC with differential.

Adverse Effects

Infusion related symptoms: fever/rigors/N/V/headache <br> Electrolyte abnormalities - hypokalemia and hypomagnesemia, loss of bicarb

Nephrotoxicity ++

Anemia

Phlebitis

Paresthesias.

Major Interactions

Enhance nephrotoxic effect with concomitant use of other nephrotoxins - use should be minimized during amphotericin therapy.

Additional Information

Lipid formulations of AmB (Ambisome, Abelcet) are NOT interchangable. <br> Premedication with acetaminophen, diphenhydramine, or hydrocortisone for infusion related symptoms.

Pharmacology

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

Average serum half life:

  • No pediatric data.

  • Liposomal: Adults: 100-153 hours (terminal half life).

  • Lipid Complex: Adults: 173 hours (terminal half life).

Route of Elimination: Lipid Complex: 0.9% of drug excreted in urine over 24h; effects of hepatic and renal impairment on drug disposition are unknown.