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

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.

See Also

• Antifungals
• Fungal infections