AMPHOTERICIN

Indications & Dose:

IV: Potentially life-threatening fungal

infections: aspergillosis (A. fumigatus), cryptococcosis (torulosis), North American blastomycosis, systemic candidiasis, coccidioidomycosis and histoplasmosis, mucormycosis due to susceptible species of the genera Absidia sp., Mucorsp., Rhizopus sp., Entomophtho rasp., and Basidiobolus sp., sporotrichosis (S. schenckii); American mucocutaneous leishmaniasis (not drug of choice as primary therapy); empirical therapy for presumed fungal infection in febrile neutropenic patients ABLC: Treatment of aspergillosis in patients refractory to or intolerant of conventional amphotericin B therapy (may have less nephrotoxicity) DOSAGE Adult and Child •

IV INF (minimum dilution 0.1 mg/ml) infuse 1 mg test dose slowly over 20-30 min to determine patient tolerance; initial therapeutic dose (if test dose tolerated) 0.25 mg/kg/day over 4-6 hr; individualize subsequent doses by increasing in 0.25 mg/kg/day increments (usual range 0.25-1 mg/kg/day); do not exceed 1.5 mg/kg/day; amphotericin cholesteryl IV INF 3-4 mg/kg/day at a rate of 1 mg/kg/hr; ABLC IV INF 5.0 mg/kg/day at a rate of 2.5 mg/kg/hr; liposomal amphotericin B LV INF 3-5 mg/kg/day over 2 hr; Intrathecal 25-100 μg q48-72 hr; increase to 500 μg as tolerated; Bladder Irrigation 5-15 mg/100 ml of sterile water irrigation solution at 100-300 ml/day; instill into bladder, clamp catheter for 60-120 minutes then drain; repeat 3-4 times/day for 2-5 days 

Contraindications:

EDUCATION • Long-term therapy may be needed to clear infection (2 wk-3 mo depending on type of infection)
MONITORING PARAMETERS • BUN, serum creatinine; if BUN exceeds 40 mg/dl or serum creatinine exceeds 3 mg/dl, discontinue the drug or reduce dosage until renal function improves •
Regular monitoring of CBC, K, Na, Mg,
LETs • Total dosage 

Side Effects:

Severe reactions may be lessened by giving acetaminophen, antihistamines, and antiemetics before infusion and by maintaining sodium balance; meperidine or hydrocortisone may also help

CNS: Chills, dizziness, fever, headache, paresthesias, peripheral nerve pain, peripheral neuropathy, seizures

CV: Cardiac arrest, dysrhythmias, hypertension, hypotension, ventricular fibrillation LENT Blurred vision, deafness, diplopia, tinnitus

GI: Acute liver failure, anorexia, cramps, diarrhea, epigastric pain, hemorrhagic gastroenteritis, nausea, vomiting

GU: Anuria, azotemia, hypokalemia, hyposthenuria, nephrocalcinosis, oliguria, permanent renal impairment (especially with doses >5 g), renal tubular acidosis

HEME: Agranulocytosis, eosinophilia, hypomagnesemia, hyponatremia, leukopenia, normochromic, normocytic anemia, thrombocytopenia

MS: Arthralgia, generalized pain, myalgia, weakness, weight loss

SKIN: Burning, irritation, pain, necrosis at injection site with extravasation; contact dermatitis, dry skin, erythema, flushing, pruritus, staining of nail lesions, stinging, urticaria 

Cautions:

Precautions:

Renal disease, rapid IV infusion, prior total body irradiation, leukocyte infusions, avoid eye contact 

Interaction:

Drugs
Aminoglycosides: Synergistic nepbrotoxicity
Cyclosporine: Increased nephrotoxicity of both drugs Neuromuscular blocking
agents: Prolonged muscle relaxation due to hypokalemia Labs  
Increase: Serum bilirubin, serum conjugated bilirubin, serum cholesterol •
Decrease: Serum unconjugated bilirubin 

Warnings:

Adverse Effects:

Lactations:

Pregnancy category B; excretion in human milk unknown: due to the potential toxicity, consider discontinuing nursing 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: