AMPHOTERICIN B (am-foe-ter'i-sin) Amphocin, Fungizone Classifications: antifungal; Therapeutic: antifungal Pregnancy Category: B; C (oral suspension) |
50 mg powder for injection; 100 mg/mL suspension; 3% cream, lotion, ointment
Fungistatic antibiotic produced by Streptomyces nodosus. Exerts antifungal action on both resting and growing cells at least in part by selectively binding to sterols in fungus cell membrane resulting in cell death.
Fungicidal at higher concentrations, depending on sensitivity of fungus.
Used intravenously for a wide spectrum of potentially fatal systemic fungal (mycotic) infections. Has been used to potentiate antifungal effects of flucytosine (Ancobon) and to provide anticandidal prophylaxis in certain susceptible patients receiving immunosuppressive therapy. Used topically for cutaneous and mucocutaneous infections caused by Candida (monilia).
Treatment of candiduria, fungal endocarditis, meningitis, septicemia; fungal infections of urinary bladder and urinary tract; amebic meningoencephalitis, and paracoccidioidomycosis.
Hypersensitivity to amphotericin; lactation.
Severe bone marrow depression; renal function impairment; anemia; pregnancy (category B), oral supsension (category C).
Systemic Infections [Amphocin, Fungizone] Adult: IV Test Dose 1 mg dissolved in 20 mL of D5W by slow infusion (over 1030 min) IV Maintenance Dose 0.250.3 mg/kg/day infused over 46 h, may gradually increase by 0.1250.25 mg/kg/d up to 11.5 mg/kg/d (max dose 1.5 mg/mg) Child: IV Test Dose 0.1 mg/kg up to 1 mg dissolved in 20 mL of D5W by slow infusion (over 10 30 min) IV Maintenance Dose 0.4 mg/kg/d infused over 46 h, may increase by 0.25 mg/kg/d to target dose of 0.251 mg/kg/d infused over 26 h (max dose 1.5 mg/kg) Candiduria [Amphocin, Fungizone] Adult: Irrigation 550 mg/1000 mL sterile water instilled continuously into the bladder via a 3-way closed drainage catheter system at a rate of 1000 mL/24 h Oral Candidiasis [Fungizone] Adult/Child: PO 100 mg swish & swallow q.i.d. Cutaneous Candidiasis [Fungizone] Adult/Child/Infant: Topical Apply to lesions 24 times/d for 14 wk Renal Impairment The dose can be reduced or interval extended. |
Intravenous PREPARE: Typically prepared by pharmacy service due to complex technique required for IV solution preparation. Each brand of amphotericin is prepared differently according to manufacturer's directions. Refer to specific manufacturer's guidelines for preparation of IV solutions. ADMINISTER: Intermittent: ??Use a 1-micron filter.??Infuse total daily dose over 26 h. Use longer infusion time for better tolerance.??Alert: Rapid infusion of any amphotericin can cause cardiovascular collapse. If hypotension or arrhythmias develop interrupt infusion and notify physician.??Protect IV solution from light during administration.??Note incompatibilities. When given through an existing IV line, flush before and after with D5W.??Initiate therapy using the most distal vein possible and alternate sites with each dose if possible to reduce the risk of thrombophlebitis.??Check IV site frequently for patency. INCOMPATIBILITIES Solution/additive: Any saline-containing solution (precipitate will form), parenteral nutrition solutions, amikacin, calcium chloride, calcium gluconate, chlorpromazine, cimetidine, ciprofloxacin, diphenhydramine, dopamine, edetate calcium disodium, gentamicin, kanamycin, magnesium sulfate, meropenem, metaraminol, meth-yldopate, penicillin G, polymyxin, potassium chloride, prochlorperazine, ranitidine, streptomycin, verapamil. Y-site: aminoglycosides, penicillins, phenothiazines, allopurinol, amifostine, amsacrine, aztreonam, bivalirudin, cefepime, cefpirome, cisatracurium, dexmedetomidine, docetaxel, doxorubicin liposome, enalaprilat, etoposide, fenoldopam, filgrastim, fluconazole, fludarabine, foscarnet, gemcitabine, granisetron, heparin (flush lines with D5W, not NS), hetastarch, lansoprazole, linezolid, melphalan, meropenem, ondansetron, paclitaxel, pemetrexed, piperacillin/tazobactam, propofol, TPNs, vinorelbine. |
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