Amphotericin B - Liposomal (AmBisome)

C difficile risk
Low
Oral Bioavailability
N/A
Cost
$200/day

Dosing

Defined criteria for use and/or important safety considerations. See below for more information.

  • Use total body weight

  • Suggest maximum dosing weight of 100 kg

  • Contact Pharmacy for dosing and pre-medication

AmBisome 3 - 5 mg/kg IV q24h infused over several hours

  • Contact Pharmacy for dosing

General Information

Primary indication(s):

  • Mucormycosis

  • Cryptococcal infections

  • Aspergillus infections

  • Blastomyces

  • Coccidioides

  • Histoplasma

  • Sporothrix

Alternative indication(s): An option for invasive Candida infections, but an echinocandin, fluconazole, or voriconazole is usually preferred.

  • 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.

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

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor

CSF penetration: Insufficient data

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