Amphotericin - Lipid Associated

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$550-650/day

General Information

Common Usage

Fungicidal therapy of yeast/fungus/mold infection.

Invasive candidiasis, aspergillosis, cryptococcosis.

Visceral/mucocutaneous Leishmaniasis.

Induction therapy for dimorphic fungii (cocci, blasto, histo).

Not for use in urinary tract infection.

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

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.

Increased digoxin toxicity with hypokalemia.

Additional Information

Please specify formulation and patient weight when ordering

IV Administration

Abelcet (Lipid Complex)
- D5W only (incompatible with NS);
- Dilute to 1-2 mg/mL.
- Administer over 2 hours.

Ambisome (Liposomal)
- D5W only (incompatible with NS);
- Dilute to 0.5-2 mg/mL.
- Administer over 1-2 hours.

EH Prescribing Restrictions
Unrestricted - Pharmacist Review of Therapy

Community IV Formulary (Metro Area)
NO

Pharmacology

Antimicrobial class: Antifungal. Polyene. Lipid formulations designed to minimize toxicity.

Average serum half life: 150 hours

Urine penetration: Poor

Lung penetration: Therapeutic

Biliary penetration: Therapeutic