AMPHOTERICIN B

Broad spectrum polyene antifungal used for severe systemic and deep mycoses. It is active against Candida spp., Aspergillus spp., Cryptococcus neoformans, Histoplasma capsulatum, Blastomyces dermatitidis, Coccidioides immitis, Paracoccidioi des brasiliensis, Mucor, Absidia, and Phicopes spp.;

It is also active against algae Prototheca spp. and against the Leishmania protozoa

Dosage Forms

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Powder for injection

50 mg

Uses

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  • Cryptococcal meningitis
  • Systemic candidiasis
  • Aspergillosis
  • Histoplasmosis
  • Coccidioidomycosis
  • Para coccidioidomycosis
  • Mucormycosis
  • Sporotrichosis
  • Blastomycosis
  • Chronic mycetoma
  • Visceral leishmaniasis
  • Disseminated cryptococcosis in children

Dose and Duration

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Systemic fungal infections
Adult and child: Initial test dose, 1 mg over 20‒30 minutes, followed by 250 micrograms/kg daily; gradually increased to 1 mg/kg daily. For severe infections, dose may be increased up to 1.5 mg/kg daily or on alternate days.
Give by slow IV infusion over 4‒6 hours

Preparation

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Note: Follow manufacturer’s instructions

  • Mix powder with 10 ml of water for injection, shake vigorously to produce a colloidal solution, then dilute further in glucose 5% to a concentration of 100 micrograms per ml.
  • Incompatible with sodium chloride 0.9% or other electrolyte solutions so do not use them for dilution

Contraindications

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  • Hypersensitivity to amphotericin B

Side Effects

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  • Stomach upset, anorexia
  • Stomach upset, anorexia
  • Hypokalaemia, hyponatremia, hypomagnesaemia, hyperglycaemia, hypocalcaemia, hyperbilirubinemia
  • Headache
  • Tachycardia, hypotension, vasodilation, flushing
  • Shortness of breath, chest pain
  • Muscle and joint pain, back pain
  • Anaemia
  • Impaired kidney function and toxicity
  • Anaphylaxis, rash
  • Pain and thrombophlebitis at injection site

Interactions

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  • Ciclosporin (increased risk of kidney toxicity)
  • Dexamethasone (increased risk of hypokalaemia)
  • Digoxin (hypokalaemia due to amphotericin B increases cardiac toxicity of digoxin)
  • Hydrocortisone (increased risk of hypokalaemia)
  • Prednisolone (increased risk of hypokalaemia)

Pregnancy

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  • Can be used

Breastfeeding

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  • Can be used

⚠️ Caution

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  • Toxicity is common. Test dose required, and monitor patient closely for at least 30 minutes after the test dose for anaphylaxis
  • Monitor liver, kidney, blood counts and plasma electrolytes while using this medicine
  • Avoid rapid infusions as they can lead to arrhythmias
  • Do not use to treat common skin infections
  • Corticosteroids may be used only if they are needed to control reactions to amphotericin B
  • Prolonged treatment is usually necessary to eliminate infection