Spectrum: Local Antimicrobial Stewardship, for IWK Health Centre

Amphotericin B liposomal (Ambisome)

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$500+/day

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

General Pediatric

3-5 mg/kg/dose IV q24h

Neonatal

Note: Refer to Amphotericin B deoxycholate (conventional) for neonatal dosing (preferred form in neonates)5 mg/kg/dose IV q24h

Renal

Contact pharmacy for more information regarding use in renal impairment.

General Information

Common Usage

Common Usage

  • Fungicidal therapy of yeast/fungus/mould infection (not for use in urinary tract infection)

  • Invasive candidiasis, aspergillosis, cryptococcosis

  • Visceral/mucocutaneous Leishmaniasis

Drug Monitoring

Drug Monitoring

  • Renal function

  • Fluid status

  • Serum electrolytes (K, Mg)

  • Liver enzymes

  • CBC with differential

Adverse Effects

Adverse Effects

  • Infusion related symptoms: fever/rigors/nausea/vomiitng/headache

  • Electrolyte abnormalities - hypokalemia and hypomagnesemia, loss of bicarbonate

  • Nephrotoxicity ++

  • Anemia

  • Phlebitis

  • Paresthesias

Major Interactions

Major Interactions

Enhance nephrotoxic effect with concomitant use of other nephrotoxins - use should be minimized during amphotericin therapy.

Additional Information

Additional Information

Lipid formulations of AmB (Ambisome, Abelcet) are NOT interchangable

Pharmacology

Pharmacology

Antimicrobial class: Antifungal - polyene - Lipid formulations (designed to minimize toxicity)

Average serum half life:

  • No pediatric data.

  • Liposomal: Adults: 100-153 hours (terminal half life)

Route of Elimination: Effects of hepatic and renal impairment on drug disposition are unknown