Amphotericin

CLINICAL USE

Antifungal agent:

Systemic fungal infections (yeasts and

yeast-like fungi including Candida
albicans

DOSE IN NORMAL RENAL FUNCTION

5 mg/kg/day for at least 14 days (see
individual product data sheet)

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
924.1

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
90

%Excreted unchanged in urine &nbsp &nbsp :
<1

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :
2286

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :
173.4/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp :
Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:
Not dialysed. Dose as in normal renal function

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
Not dialysed. Dose as in normal renal function

HDF/high flux &nbsp :
Unknown dialysability. Dose as in
normal renal function

CAV/VVHD &nbsp &nbsp &nbsp:
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 individual data sheet. Prepare

intermittent infusion in glucose 5%
(incompatible with sodium chloride 0.9%,
electrolytes or other drugs).

Dilute to a concentration of 1–2 mg/mL

Route

IV infusion

Rate of Administration

2.5 mg/kg/hour

Comments

Paracetamol and parenteral pethidine

may alleviate rigors associated with
amphotericin administration. Can also use
antihistamines 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 15 minutes)

Monitor renal function, full blood count,

potassium, magnesium and calcium levels

Liposomal amphotericin is considerably

less nephrotoxic compared with
conventional amphotericin B, but is
considerably more expensive

Tags: post-by-auto-php