Ambisome
CLINICAL USE
Antifungal agent:
Systemic fungal infections (yeasts and
yeast-like fungi including Candida
albicans)
Treatment of visceral leishmaniasis
DOSE IN NORMAL RENAL FUNCTION
1–3 mg/kg/day, maximum 5 mg/kg
(unlicensed dose)
Visceral leishmaniasis: total dose of
21–30 mg/kg given over 10–21 days
PHARMACOKINETICS
924.1
90
2–5
0.1–0.44
6.3–10.7/Unchanged
DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
Dose as in normal renal function
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
Not dialysed. Dose as in normal renal function
Not dialysed. Dose as in normal renal function
Unknown dialysability. Dose as in
normal renal function
Not dialysed. Dose as in normal renal function
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Ciclosporin: increased nephrotoxicity
Tacrolimus: increased nephrotoxicity
Increased risk of nephrotoxicity with
aminoglycosides and other nephrotoxic
agents and cytotoxics
Cardiac glycosides: increased toxicity if
hypokalaemia occurs
Corticosteroids: increased risk of
hypokalaemia (avoid concomitant use
unless corticosteroids are required to
control reactions)
Flucytosine: enhanced toxicity in
combination with amphotericin
ADMINISTRATION
Reconstition
See SPC. Prepare intermittent infusion
in glucose 5% (incompatible with sodium
chloride 0.9%, electrolytes or other drugs).
Reconstitute vial contents with water for
injection
Dilute to a concentration of 0.2–2 mg/mL
Route
IV infusion
Rate of Administration
30–60 minutes
Comments
Paracetamol and parenteral pethidine
may alleviate rigors associated
with amphotericin administration.
Antihistamines can also be administered
to control reactions
Flush existing IV line with glucose 5%
before and after infusion administration
For patients on CAV/VVHD, amphotericin
should be given into the venous return of
the dialysis circuit
Should be given post dialysis
OTHER INFORMATION
*** AMPHOTERICIN IS HIGHLY
NEPHROTOXIC ***
Can cause distal tubular acidosis
May cause polyurea, hypovolaemia,
hypokalaemia and acidosis.
Amphotericin and flucytosine act
synergistically when co-administered
enabling lower doses to be used effectively
A test dose of amphotericin is
recommended at the beginning of a new
course (1 mg over 10 minutes then stop
and observe for next 30 minutes)
Monitor renal function, full blood count,
potassium, magnesium and calcium levels
Liposomal amphotericin is considerably
less nephrotoxic compared with
amphotericin, but is considerably more
expensive