Amphotericin - Liposomal (Ambisome)

Amphotericin - Liposomal (Ambisome)



Spectrum of Activity

General Information

Fungicidal therapy of yeast or mold infection.

Invasive candidiasis, aspergillosis, cryptococcosis.

Visceral/mucocutaneous Leishmaniasis.

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

  • Renal function
  • K+
  • Mg++
  • Liver enzymes
  • CBC

Frequency depends on course, but daily reasonable during initiation.

Same toxicities as conventional Amphotericin B but with less frequency.

  • Nephrotoxicity ++
  • Anemia, leukopenia, thrombocytopenia
  • Phlebitis
  • Paresthesia

Infusion-related symptoms

  • Fever
  • Rigors
  • N/V
  • Headache

Electrolyte abnormalities

  • HypoK and HypoMg

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

  • Increased digoxin toxicity with hypokalemia
  • Increased risk of nephrotoxicity with cyclosporine
  • Lipisomal AmB is taken up preferentially by phagocytic cells and concentrated at sites of infection while minimizing renal exposure.
  • Premedication with acetaminophen, diphenhydramine, or hydrocortisone may be 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.
  • Cost based on average adult dose (70kg) of 5mg/kg IV q24h.

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

Pregnancy Category: B (per conventional form)

Average serum half life: 7-10 hours, can be prolonged with very long durations of therapy

Urine penetration: Poor

Lung penetration: Therapeutic

Biliary penetration: Therapeutic