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Amphotericin B



Amphotericin B is a polyene macrolide with antifungal activity. It is available in 4 formulations: conventional amphotericin B (C-AMB), liposomal amphotericin B (L-AMB), amphotericin B lipid complex (ABLC), and amphotericin B colloidal dispersion (ABCD). It binds to ergosterol in the fungal cell membrane making it permeable and causing loss of intracellular molecules. (1)

Empirical therapy for presumed fungal infection in febrile, neutropenic patients. Treatment of Cryptococcal Meningitis in HIV infected patients. Treatment of patients with Aspergillus species, Candida species and/or Cryptococcus species infections. Treatment of visceral leishmaniasis. (2)

Hypersensitivity to amphotericin B or any other component of the formulation (2)

Abdominal pain, asthenia, back pain, transfusion reaction, chills, Chest pain, hypertension, hypotension, tachycardia Diarrhea, nausea, vomiting, GI hemorrhage. Increased Liver function and kidney function test levels. Hyperglucemia, hypernatremia, hypervolemia, hypocalcemia, hypokalemia, hypomagnesemia Anxiety, confusion, headache, insomnia Cough, dyspnea, epistaxia, hypoxia, pleural effusion, rhinitis Pruritis, rash, sweating, hematuria (2)

Antineoplastic agents: Increased chances of renal toxicity, bronchospasm, and hypotension. Corticosteroids and Corticotropin, Digitalis Glycosides: Increased incidence of hypokalemia Flucytosine: Impairment of renal function Azoles: May induce resistance to amphotericin B Leukocyte Transfusions: Acute pulmonary toxicity Other Nephrotoxic Medications: Increased incidence of nephrotoxicity Skeletal Muscle Relaxants: Enhanced effects of skeletal muscle relaxants (2)

Amphotericin B appears in human milk and might cause adverse effects in nursing child. Safety and efficacy is not established in <1 month of age (2)

Intravenous infusion (plain) Adult- Systemic fungal infection: 250 µg/kg body weight daily, increase gradually 1 mg/kg body weight if tolerated (max 1.5 mg/kg body weight daily) or alternate days. Child-Same as for Adult based on body weigh Intravenous (liposomal) For fever in neutropenic patients: 3 mg/kg/day, max. dose 5 mg/kg/day i.v. For cryptococcal meningitis: 3-4 mg/kg, max. 6 mg/kg, i.v. once daily. Visceral leismaniasis: Immunocompetent patients: 3 mg/kg. Immunocompromized patients: 4 mg/kg. (3)

1. Bennett JE. Antifungal agents. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. P1571- 91. 2. AmBisome [cited 2013 Sept 8]. Available from: 3. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011.