Amphotericin B

Indications
Oral
Oral candidiasis
Adult: Using conventional amphotericin B: 1 ml of a 100 mg/ml oral suspension 4 times daily retained in the mouth for a few minutes before swallowing or 10 mg loz dissolved in the mouth 4 times daily, increased to 8 loz daily if necessary or 100-200 mg tab/suspension 4 times daily. Continue for 48 hr after lesions have cleared.
Intravenous
Severe systemic fungal infections
Adult: Using conventional amphotericin B: If needed, test dose of 1 mg infused over 20-30 minutes. Initial dose: 250 mcg/kg daily, increased gradually to a max of 1 mg/kg/day. For seriously ill patients, up to 1.5 mg/kg may be given daily or on alternate days may be needed. Daily dose is infused over 2-4 hr at a concentration of 100 mcg/ml in glucose 5%. If treatment is interrupted for more than 7 days, then restart at 250 mcg/kg daily and increase slowly.
Intrathecal
Severe meningitis
Adult: Using conventional amphotericin B: If needed, test dose of 1 mg infused over 20-30 minutes. Initially, 25 mcg increased gradually to the max that can be tolerated without excessive discomfort. Usual dose: 0.25-1 mg 2-4 times a wk.
Intravenous
Aspergillosis, disseminated
Adult: Using conventional amphotericin B: If needed, test dose of 1 mg infused over 20-30 minutes. 0.6-0.7 mg/kg daily for 3-6 mth.
Intravenous
Endocarditis
Adult: Using conventional amphotericin B: If needed, test dose of 1 mg infused over 20-30 minutes. 0.6-1 mg/kg/day for 1 wk, then 0.8 mg/kg/day every other day for 6-8 wk post-operatively.
Irrigation
Candiduria
Adult: Using conventional amphotericin B: 50 mg daily in 1000 ml of sterile water by continuous bladder irrigation for 5-10 days or until cultures are clear.

Reconstitution: For conventional amphotericin B: Reconstitute with sterile water for inj (without preservatives), then further dilute with glucose inj 5% (with a pH>4.2) to a final concentration not exceeding 0.1 mg/ml for peripheral infusion or 0.25 mg/ml for central infusion.
Incompatibility: Precipitation may occur if added to normal saline or electrolyte solutions.
Contraindications
Hypersensitivity; lactation; do not give to patients receiving antineoplastics.
Warnings / Precautions
Renal and hepatic impairment; pregnancy; monitor renal and liver function changes.
Adverse Reactions
Topical: Local irritation, pruritus and skin rash. IV infusion: Fever, chills, convulsions, malaise; nausea, vomiting, diarrhoea, anorexia; tinnitus, vertigo, hearing loss; hypotension, hypertension, cardiac arrhythmias; peripheral neuropathy; phloebitis, pain at Inj site, disturbances in renal function and renal toxicity.
Potentially Fatal: Anaphylactic reaction; leucoencephalopathy. Overdosage can result in cardio-respiratory arrest.
Overdose Reactions
May result in cardiac arrest.
Drug Interactions
Increased toxicity with flucytosine. Drug induced renal toxicity enhanced in presence of other nephrotoxic medications. Antagonises effects of azole antifungals.
Potentially Fatal: Potentiates K loss by corticosteroids. Avoid diuretics. Enhances digitalis toxicity and neuromuscular blocker effects.
See Below for More amphotericin b Drug Interactions
Mechanism of Actions
Amphotericin B is a polyene antifungal antibiotic which alters cell membrane permeability by binding to ergosterol, thus causing leakage of cell components and subsequent cell death. It is active against Absidia spp, Aspergillus spp, Basidiobolus spp, B. dermatitidis, Candida spp, C. immitis, Conidobolus spp, C. neoformans, H. capsulatum, Mucor spp, P. brasiliensis, Rhizopus spp, Rodotorula spp. and S. schenckii.
Absorption: Little or no absorption from the GI tract (oral).
Distribution: Distributed widely, CSF (small quantities).
Excretion: Via urine (small amounts); not removed by dialysis; 24 hr (elimination half-life); may be increased to 15 days in long-term treatment.
Storage Conditions
Intrathecal: Store at 2-8°C. Intravenous: Intact vials: Store at 2-8°C. Reconstituted vials: If protected from light, stable for 24 hr at room temperature and 1 wk if refrigerated. Parenteral admixtures: If protected from light, stable for 24 hr at room temperature and 2 days if refrigerated. Irrigation: Store at 2-8°C. Oral: Store at 2-8°C.
ATC Classification
A01AB04 - amphotericin B ; Belongs to the class of local antiinfective and antiseptic preparations. Used in the treatment of diseases of the mouth.
G01AA03 - amphotericin B ; Belongs to the class of antibiotics. Used in the treatment of gynecological infections.
J02AA01 - amphotericin B ; Belongs to the class of antibiotics. Used in the systemic treatment of mycotic infections.
A07AA07 - amphotericin B ; Belongs to the class of antibiotics. Used in the treatment of intestinal infections.
Storage
Intrathecal: Store at 2-8°C. Intravenous: Intact vials: Store at 2-8°C. Reconstituted vials: If protected from light, stable for 24 hr at room temperature and 1 wk if refrigerated. Parenteral admixtures: If protected from light, stable for 24 hr at room temperature and 2 days if refrigerated. Irrigation: Store at 2-8°C. Oral: Store at 2-8°C.
Available As
  • Amphotericin B 0.1% w/w
  • Amphotericin B 10 mg
  • Amphotericin B 100 mg
  • Amphotericin B 1000 mg
  • Amphotericin B 25 mg
  • Amphotericin B 50 mg
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