Amphotericin - Lipid Associated

C. diff Risk

Low

Oral Bioavailability

NA

Spectrum Of Activity

Dosing

Ambisome
3-6mg/kg IV daily infused over several hours

Discuss dosing as well as premedication with pharmacy.

No adjustment required for renal impairment.

If intermittent dialysis, give dose after dialysis.

Liaise with Pharmacist

General Information

  • Renal function

  • K

  • Mg

  • HCO3

  • Liver enzymes

  • CBC

Frequency depends on course, but daily reasonable during initiation.

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

Main concern is concomitant nephrotoxins. Use should be minimized during amphotericin therapy.

Increased digoxin toxicity with hypokalemia.

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

Premedication with acetaminophen, diphenhydramine, or hydrocortisone are used.

Meperidine may be used for rigors.

Pay careful attention to electrolyte and fluid status with boluses (usually 500mL) before and after infusion, as well as K and Mg supplementation PRN.

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

Pregnancy category: B

Average serum half life: 150 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor

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.