Amphotericin-B

Details About Generic Salt ::  Amphotericin-B 

Main Medicine Class:: Anti Infectives   Sub Medicine Class ::  Anti Fungals

13I. ANTI-FUNGALS in 13. ANTI-INFECTIVES
AMPHOTERICIN-B
POLYENE ANTIFUNGAL (SYSTEMIC) | ANTI-FUNGAL
PK: A: Poor D: 4L/kg E: Urine (3% unchanged)

Indications & Dose: BLASTOMYCOSIS IV Adult 0.5-1 mg/kg/day | BONE MARROW TRANSPLANTATION Prophylactic therapy IV Adult 0.1-0.25mg/kg/day | CANDIDIAL MENINGITIS IV Adult 0.7-1mg/kg/day (with/without flucytosine) 4 wk | CANDIDURIA Adult 50mg in 1L of sterile water as continuous bladder irrigation | CNS DISEASE IV Child HIV exposed/positive: 0.7-1mg/kg/day with flucytosine | COCCIDIOIDOMYCOSIS IV Adult 0.5-1.5mg/kg ODHIV exposed/positive | CRYPTOCOCCAL PNEUMONIA Mild-to-moderate IV Adult HIV positive:0.5-1mg/kg/day, HIV negative:0.5-0.7mg/kg/day 2 wk | CRYPTOCOCCAL/COCCIDIOIDES MENINGITIS IT Adult Initially 0.01-0.05mg as single dose, may increase to 0.025-0.1mg, max 1.5mg/day | CRYPTOCOCCOSIS IV Child HIV exposed/positive : 0.7-1mg/kg/day with flucytosine | CRYPTOCOCCOSIS (NON-CNS DISEASE) IV Child HIV exposed/ positive: 0.7-1mg/kg/day with/without flucytosine | DEMATIACEOUS FUNGI Combination therapy IV Adult 0.7mg/kg/day with azoles | DISSEMINATED ASPERGILLOSIS IV Adult 0.6-0.7mg/kg/day 3-6 month Child 1-1.5mg/kg OD | DISSEMINATED CANDIDIASIS IV Adult 0.5-0.7mg/kg/day 3-6 month | ENDOCARDITIS IV Adult 0.6-1mg/kg/day 6 wk with/without flucytosine after valve replacement | ESOPHAGEAL CANDIDIASIS IV Adult 0.3-0.7mg/kg/day 2-3 wk Child HIV exposed/ positive: 0.3-0.5mg/kg/day | HISTOPLASMOSIS IV Adult 0.5-1mg/kg/day 1 wk, then 0.8mg/kg thrice weekly 3 month, followed with fluconazole suppressive therapy up to 12 month | INVASIVE CANDIDIASIS IV Child 0.5-1.5mg/kg/dayHIV exposed/positive | MENINGOENCEPHALITIS IV Adult HIV positive: 0.7-1mg/kg/day 2 wks (along with flucytosine 100mg/kg/day) HIV negative: 0.7-1mg/kg/day 2 wks (along with flucytosine 100mg/kg/day) continue if no neurological complications | NEUTROPENIC CANCER PATIENTS Prophylactic therapy IV Adult 0.1mg/kg OD | OROPHARYNGEAL CANDIDIASIS IV Adult 0.3mg/kg/day 1-2 wk Child 0.3-0.5mg/kg/dayHIV exposed/positive | OSTEOARTICULAR CANDIDIASIS IV Adult 0.5-1mg/kg/day for several wk, followed by fluconazole 6-12 month for osteomyelitis | PROGRESSIVE DISSEMINATED HISTOPLASMOSIS IV Child 1mg/kg/day 4-6 wk | SEVERE PULMONARY DISEASE IV Adult 0.5-0.1mg/kg/day 1wk, then 0.8mg/kg thrice weekly, total dose of 10-15mg/kg Child HIV exposed/ positive: 0.7-1mg/kg/day with/without flucytosine | SPOROTRICHOSIS IV Adult 1-2g

Contra: Hypersensitivity, patients receiving nephrotoxic drugs

Precautions: Avoid rapid infusion

ADR: Serious: hypotension/HTN, tachypnea, hypokalemia, hypomagnesemia, renal impairment, paresthesia, arrhythmia, bone marrow suppression, bronchospasm, cardiac arrest, SJS, TEN, Others: plebitis/thrombophlebitis, myalgia, anorexia, nausea, anemia, increased LFTs

DDI: Serious Loop diuretics/Corticosteroids/Thiazides causes hypokalemia, Ifosfamide/Cisplatin/Methotrexate/Tenofovir increases risk of renal impairment, Sotalol leads to arrhythmias, Digoxin leads to digitalis toxicity, Tacrolimus leads to renal toxicity & nephrotoxicity, Itraconazole reduces drug efficacy & leads to hepatotoxicity, Ciclosporin results nephrotoxicity, Flucytosine toxicity increases

Monitor: Renal function, LFTs, electrolytes, PT, PTT, CBC, hypokalemia

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