Amphotericin B

Administration

• Type: Antifungal
• Dosage Forms:
• Routes of Administration: IV
• Common Trade Names: AmBisome, "ampho-terrible"

Adult Dosing

Dosing is NOT interchangeable between different formulations of amphotericin B due to significant variations in pharmacokinetics. Call your institution's pharmacy (or ID) if unsure about correct dose.

Special Populations

• Pregnancy Rating: B
• Lactation risk: Infant risk cannot be ruled out

Renal Dosing

• Adult:
• Pediatric:

Hepatic Dosing

• Adult:
• Pediatric:

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Nephrotoxicity/renal failure, hemorrhagic cystitis
• Anaphylaxis
• Cardiac arrest

Common

• Hypokalemia, hypomagnesemia, hyperglycemia (check BMP at least daily)
• Rigors
• Nausea/vomiting, diarrhea
• Anemia
• Rash
• Dyspnea
• Insomnia

Pharmacology

• Half-life: Depends on formulation, 1-14 days
• Metabolism: unknown
• Excretion:

Mechanism of Action

• Binds to ergosterol in fungal cell membranes→ intracellular contents leak out→ cell dies

Comments

Amphotericin B is an antifungal agent used to treat severe or disseminated fungal infections (e.g. invasive aspergillosis, cryptoccoccal meningitis, coccidioidomycosis, mucormycosis, fungemia in neutropenic patients). It comes in several formulations; conventional, cholesteryl sulfate complex, lipid complex, and liposomal. It is usually reserved for serious infection due to significant associated toxicities, though the newer formulations tend to be better tolerated.

References

Authors

Claire, Ross Donaldson, Michael Holtz