Amphotericin - Conventional

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Dosing

Adult

Different than liposomal formulation

0.3-1.5mg/kg IV daily, infused over several hours.

Discuss with infectious diseases or pharmacy for dosing and for managing infusion-related reactions

General Information

Common Usage

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)

Drug Monitoring

  •  Renal function

  •  K

  •  Mg

  •  HCO3

  •  Liver enzymes

  •  CBC

Frequency depends on course, but daily reasonable during initiation

Adverse Effects

  •  Nephrotoxicity ++

  •  Anemia

  •  Phlebitis

  •  Arachnoiditis

  •  Urinary retention

  •  Paresthesias

Infusion related symptoms

  •  Fever

  •  Rigors

  •  N/V

  •  Headache

  •  See "Additional Information"

Electrolyte abnormalities

  •  HypoK and HypoMg

  •  Loss of bicarb

  •  See "Additional Information"

Major Interactions

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

Digoxin - increased digoxin toxicity with hypokalemia

Additional Information

Routine premedication no longer recommended. Manage infusion-related reaction symptoms if needed with acetaminophen and/or diphenhydramine. Meperidine may be used for rigors.

Careful attention to electrolyte and fluid status with boluses (usually 500mL) of NS before and after infusion, as well as K and Mg supplementation PRN

Pharmacology

Antimicrobial class: Antifungal - polyene

Pregnancy category: B

Average serum half life: 24.0

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic