Antimicrobials
Amphotericin - Lipid Associated

Amphotericin - Lipid Associated

Restricted

Low
N/A

Spectrum of Activity

Dosing

General Information

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.

RECOMMENDED

  • Baseline serum creatinine, serum electrolytes (especially potassium and magnesium), complete blood count with differential, then monitor weekly
  • Baseline AST, ALT, alkaline phosphatase and bilirubin, then Monitor weekly
  • Monitor volume status and weight throughout therapy to prevent sodium depletion and dehydration

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

Neuromuscular blocking agents, digoxin, antiarrhythmics:

  • Amphotericin induced hypokalemia may enhance effects and/or toxicity

Other nephrotoxic drugs:

  • Concomitant use may enhance amphotericin B nephrotoxicity (eg vancomycin, aminoglycosides, pentamidine, cycloSPORINE, CISplatin)

Loop/thiazide diuretics, long term steroids, laxatives:

  • Increased risk for hypokalemia/hypomagnesemia
  • Monitor potassium closely
  • May still need additional potassium supplementation

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

Precautionary measures for the prevention or treatment of infusion reaction are:

  • Slow infusion rate to be over 2 hours
  • Routine doses of diphenhydramine, paracetamol and hydrocortisone A

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

Average serum half life: 150 hours

Urine penetration: Poor

Lung penetration: Therapeutic

Biliary penetration: Therapeutic

Pregnancy: Category B

Breastfeeding: No information exists on the milk excretion of amphotericin B, as per Lact med Ref.