amphotericin B (Fungisone, Ambisone, Amphotec, Fungilin, LAMB, AmBisome)

From Aaushi
Jump to navigation Jump to search

Introduction

Tradename: Fungizone, AmBisome

Indications

Dosage

(administration)

  • test dose: 1 mg slow IV
  • then, begin 0.25 mg/kg IV QD & gradually increase to 1-1.5 mg/kg/day.

Amphotericin will precipitate if mixed with electrolyte solutions.

* slower infusion (over 24 hours) may produce fewer adverse effects

Test doses have been advocated to identify patients prone to severe infusion-related adverse effects. A 1 mg test dose may be given over 30 minutes &, if well tolerated, a separate infusion of 0.2-0.5 mg/kg may follow. Dosage can be increased until a therapeutic or maximum tolerated dose is reached, generally 0.5-1.0 mg/kg/day, given over a period of 2-5 hours. 50 mg/day is a standard dose. Dosage may be doubled & given on alternate days, but dose should not exceed 1.5 mg/kg/day.

Intrathecal or intraventricular administration of amphotericin is occasionally used in conjunction with expert consultation.

Bladder irrigation: Continuous irrigation with amphotericin B, 50 mg in 1 liter of sterile water for 3-5 days may be useful in treatment of fungal cystitis.

Topical agent: (oropharyngeal candidiasis) 3% cream/lotion/ointment BID/QID.

aerosolized Liposomal AMphotericin-B (LAMB)[8]

AmBisome; 12.5 mg delivered using an adaptive aerosolized system, or 30 minutes on 2 consecutive days each week until recovery from neutropenia[8]

Pharmacokinetics

elimination via liver

Adverse effects

Drug interactions

Mechanism of action

Notes

Amphotericin B is a polyene antimicrobial produced by Streptomycetes nodosus M4575 that disrupts fungi via binding to ergosterol in the fungal plasma membrane. Amphotericin is fungicidal.

More general terms

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996.
  2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 294-95
  3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 598
  5. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  6. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  7. Journal Watch 21(9):72, 2001 Eriksson et al, BMJ 322:579, 2001
  8. 8.0 8.1 8.2 8.3 Rijnders BJ et al. Aerosolized liposomal amphotericin B for the prevention of invasive pulmonary aspergillosis during prolonged neutropenia: A randomized, placebo-controlled trial. Clin Infect Dis 2008 May 1; 46:1401. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18419443
  9. 9.0 9.1 Bicanic T et al, High-dose amphotericin B with flucytosine for the treatment of cryptococcal meningitis in HIV-infected patients: A randomized clinical trial. Clin Infect Dis 2008, 47:123 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18505387
  10. 10.0 10.1 10.2 Deprecated Reference

Database