Amphotericin B - Lipid Associated

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Dosing

Amphotericin B - liposomal (Ambisome) - 3-6mg/kg IV daily infused over several hours

Amphotericin B - lipid complex (Abelcet) - 5mg/kg IV daily infused over several hours

Use must be approved by Infectious Diseases

Discuss dosing with Pharmacy

This antimicrobial is restricted to Infectious Diseases

General Information

Common Usage

Amphotericin B is often used as fungicidal therapy for various invasive fungal infections.

Drug Monitoring

Daily serum CBC, creatinine and electrolytes, including magnesium levels, and liver enzymes.

Adverse Effects

Infusion related symptoms including fever, rigors, nausea, emesis and headache.

Electrolyte abnormalities, including hypokalemia and hypomagnesemia with loss of bicarbonate may occur.

Nephrotoxicity

Anemia

Phlebitis

Major Interactions

Use of concomitant nephrotoxins may increase risk of nephrotoxicity.

Concomitant use of digoxin can increase risk of digoxin toxicity and hypokalemia.

Additional Information

Use must be approved by Infectious Diseases.

Lipid formulations of Amphotericin B carry lower risk of infusion related reactions, nephrotoxicity and electrolyte disturbances than Amphotericin B deoxycholate.

Monitor electrolytes and volume status closely. Pre- and post-infusion hydration with 500mL normal saline can reduce risk of renal injury.

Lipid formulations of Amphotericin B have poor urinary penetration.

DO NOT mistake lipid based Amphotericin B for Amphotericin B deoxycholate - FORMULATIONS ARE NOT INTERCHANGEABLE

Pharmacology

Antimicrobial class: Antifungal - Polyene

Average serum half life: 150 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor