Antimicrobials
Amphotericin - Conventional

Amphotericin - Conventional

Low
N/A
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status Yes (parenteral inj, powder for compounding)

In-Hospital Cost will be updated

PharmaCare Formulary Status Yes (parenteral inj, powder for compounding)

Special Authority None

PharmaCare Coverage 50mg powder for soln - $95.85/vial

Outpatient Cost 50mg powder for soln - $95.85-105.44/vial

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)

  •  Renal function
  •  K
  •  Mg
  •  HCO3
  •  Liver enzymes
  •  CBC

Frequency depends on course, but daily reasonable during initiation

Careful attention to electrolyte and fluid status with boluses (usually 500ml) of NS before and after infusion

Nephrotoxicity (IV)

  •  reversible and often transient decline in GFR
  •  increase in SCr above baseline
  •  more nephrotoxic than lipid-based formulations
  • to ameliorate GFR decline: volume expansion with 500ml of 0.9% IV sodium chloride before infusion or divided before and after

Infusion-related reactions (IV)

  •  sx: fever, headache, nausea, vomiting, chills and rigors
  •  usually occurs within 15 mins to 3 hrs following initiation or immediately following administration
  •  treatment: acetaminophen (fever), diphenhydramine or promethazine or prochlorperazine or ondansetron (nausea and vomiting), meperidine (chills and rigors), ibuprofen (chills)

Phlebitis (IV)

  • complication of infusions via a small peripheral vein
  •  can be minimized by infusion using a central line, use of alternating infusion sites, avoiding concentrations >0.1mg/ml and avoiding infusion times < 4 hrs

Electrolyte abnormalities (IV)

  •  hypoK, hypoMg and hyperchloremic acidosis (loss of bicarb)
  •  caused by increase in distal tubular membrane permeability
  •  treatment: K and Mg supplementation PRN

Anemia (IV)

  • reversible, normochromic, normocytic anemia
  • onset may be delayed for as long as 10 weeks after initiation

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

Digoxin - increased digoxin toxicity with hypokalemia

Antimicrobial class: Antifungal, Polyene

Pregnancy category: B

Average serum half life: 24.0 hr

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Therapeutic