Amphotericin - Lipid Associated

Restricted
C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$$$$

Spectrum Of Activity

Dosing

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

Abelcet - 5mg/kg IV daily infused over several hours

Discuss with dosing and premedication with Pharmacy

Use total body weight for dosing. For patients with BMI >/= 35, adjusted body weight (AdjBW) is recommended

CrCl >50 mL/minCrCl <50 mL/min3-5 mg/kg/dose IV Q24hDose adjustment is unnecessary for pre-existing renal dysfunction however, decreased renal function caused by amphotericin may warrant dose adjustment (e.g. dose reduction or q48h dosing)

Creatinine Clearance >50mL/min/1.73m²Creatinine Clearance ≤50mL/min/1.73m²5mg/kg/dose Q24HNo change

Dosage reductions in renal disease not necessary. Due to nephrotoxic potential, reducing ABLC dose or holding drug may be warranted if serum Cr is rising.

Restricted to use by Adult or Pediatric Infectious Diseases Service approval.

General Information

  • Lower incidence of nephrotoxicity than amphotericin B deoxycholate

  • Infusion-related effects

  • Electrolyte disturbances (hypokalemia, magnesemia)

Laboratory

  • Twice-weekly Cr, K, Mg

  • Weekly LFTs and CBC

Clinical

  • Infusion-related effects

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

Digoxin - 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.

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)

Average serum half life: 150 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor

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)