Amphotericin - lipid associated

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$500+/day

Spectrum Of Activity

Dosing

Contact pharmacy for more information regarding use in renal impairment.

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

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.

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

Renal function, fluid status, serum electrolytes (K, Mg).

Liver enzymes, CBC with differential.

Adverse Effects

Infusion related symptoms: fever/rigors/N/V/headache

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.

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.