Restricted
Fungicidal therapy of yeast/fungus/mold infection.
Invasive candidiasis, aspergillosis, cryptococcosis.
Visceral/mucocutaneous Leishmaniasis.
Induction therapy for dimorphic fungii (cocci, blasto, histo).
Frequency depends on course, but daily reasonable during initiation
Toxicities as conventional Amphotericin B but with less frequency.
Electrolyte abnormalities
Infusion related symptoms
Ambisome - infusion reaction known as "classic triad"
Abelcet - similar infusion reactions as ampho deoxycholate but to a lesser degree
Main concern is concomitant nephrotoxins. Use should be minimized during amphotericin therapy.
Increased digoxin toxicity with hypokalemia.
Liposomal amphotericin is BC formulary agent. May consider premedication with diphenhydramine. Less common infusion reactions with Ambisome than other market agents. Infusion reaction with Ambisome - classic triad:
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