Amphotericin B
Administration
- Type: Antifungal
- Dosage Forms: powder for injection
- Dosage Strengths: 50mg/vial
- Routes of Administration: IV
- Common Trade Names: AmBisome, Fungizone "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.
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Cryptococcosis | 0.7-1mg/kg IV q24hrs | Meningitis not AIDS with Flucytosine x 4 weeks |
| Cryptococcosis | 0.7-1mg/kg IV q24hrs | Meningitis with AIDS with Flucytosine x 2 weeks |
Pediatric Dosing
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Cryptococcosis | 0.7-1mg/kg IV daily x 2-4 weeks | Pediatric Meningitis |
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: urine
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.