Amphotericin - Liposomal

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$500+/day

Dosing

Adult

Different than conventional formulation

3-6mg/kg IV daily infused over several hours (see IV monograph)

Discuss with pharmacy or infectious diseases for dosing

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

  • K

  • Mg

  • HCO3

  • Liver enzymes

  • CBC

Frequency depends on course, but daily reasonable during initiation

Adverse Effects

Same toxicities as conventional Amphotericin B but with less frequency.

  •  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

Lipid associated AmB is taken up preferentially by phagocytic cells and concentrated at sites of infection while minimizing renal exposure.

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) before and after infusion, as well as K and Mg supplementation PRN.

Pharmacology

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

Average serum half life: 150.0

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor