Low
NA
$500+/day
Fungicidal therapy of yeast/fungus/mold infection (not for use in urinary tract infection)
Invasive candidiasis, aspergillosis, cryptococcosis
Visceral/mucocutaneous Leishmaniasis
Induction therapy for dimorphic fungii (cocci, blasto, histo)
Renal function, K, Mg, HCO3, liver enzymes, CBC. Frequency depends on course, but daily reasonable during initiation
Same toxicities as conventional Amphotericin B but with less frequency
Infusion related symptoms: fever/rigors/N/V/headache (see additional information)
Electrolyte abnormalities - hypoK and hypoMg, loss of bicarb (see additional information re: electrolyte infusions)
Nephrotoxicity ++
Anemia
Phlebitis
Arachnoiditis
Urinary retention
Paresthesias
Main concern is concomitant nephrotoxins - use should be minimized during amphotericin therapy
Digoxin - increased digoxin toxicity with hypokalemia
Lipid associated AmB is taken up preferentially by phagocytic cells and concentrated at sites of infection while minimizing renal exposure
Premedication with acetaminophen, diphenhydramine, or hydrocortisone are used, see SCM orderset. Meperidine may be used for rigors.
Careful attention to electrolyte and fluid status with boluses (usually 500mL) before and after infusion, as well as K and Mg supplementation PRN
Antimicrobial class: Antifungal - polyene - Lipid formulations (designed to minimize toxicity)
Average serum half life: 150.0
Biliary penetration: Therapeutic
Lung penetration: Therapeutic
Urine penetration: Poor
