Dangerous Drug: Amphotericin B(am foe ter’ i sin)
Amphotericin B Cholesteryl Sulfate Amphotericin B, Liposome
Abelcet, AmBisome, Amphotec
PREGNANCY CATEGORY B
Drug class
Antifungal
Therapeutic Actions
Binds to sterols in the fungal cell membrane with a resultant change in membrane permeability, an effect that can destroy fungal cells and prevent their reproduction; fungicidal or fungistatic depending on concentration and organism.
Indications
Reserve use for patients with progressive, potentially fatal infections: Cryptococcosis; North American blastomycosis; systemic candidiasis; disseminated moniliasis; coccidioidomycosis and histoplasmosis; mucormycosis caused by species of Mucor, Rhizopus, Absidia, Conidiobolus, Basidiobolus; sporotrichosis; aspergillosis. Not for use in treating noninvasive fungal infections
Adjunct treatment of American mucocutaneous leishmaniasis (not choice in primary therapy)
Treatment of aspergillosis in patients refractory to conventional therapy (Abelcet, Amphotec)
Treatment of cryptococcal meningitis in HIV-infected patients (AmBisome)
Treatment of invasive aspergillosis where renal toxicity precludes use of conventional amphotericin B (Amphotec)
Treatment of presumed fungal infections in febrile, neutropenic patients (AmBisome)
Treatment of Aspergillus, Candida, or Cryptococcus infections in patients intolerant to or refractory to conventional amphotericin B (AmBisome)
Treatment of visceral leishmaniasis (AmBisome)
Treatment of any type of progressive fungal infection that does not respond to conventional therapy
Unlabeled uses: Prophylactic to prevent fungal infections in bone marrow transplants, bladder irrigation for candidal cystitis, primary treatment of amoebic meningoencephalitis, ocular aspergillosis, treatment of severe meningitis in patients unresponsive to IV therapy (intrathecal administration)
Contraindications and Cautions
Contraindicated with allergy to amphotericin B, renal impairment, lactation (except when life-threatening and treatable only with this drug).
Use cautiously with pregnancy.
Available Forms
Injection—50 mg; suspension for injection—5 mg/mL; powder for injection—50, 100 mg/vial
Dosages
Adults and pediatric patients
Abelcet
Consider test dose; if tolerated, may proceed to regular dosing regimen.
Fungal infections, systemic: 5 mg/kg/day given as a single infusion at 2.5 mg/kg/hr.
Amphotec
Use test dose (10 mL of final preparation infused over 15–30 min).
Aspergillosis: Initially, 3–4 mg/kg/day IV. Infuse at 1 mg/kg/hr.
AmBisome
Consider test dose; if tolerated, may proceed to regular dosing regimen.
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