DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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. pH should be adjusted to >4.2
Dilute to a concentration of 10 mg in

100 mL

Route

IV infusion

Rate of Administration

2–6 hours

If given over 12–24 hours there is a

reduced incidence of side effects

Comments

Minimum volume peripherally 0.2 mg/mL,

centrally 0.5 mg/mL. (UK Critical Care
Group, Minimum Infusion Volumes for
fluid restricted critically ill patients, 3rd
Edition, 2006)
Higher rates of infusion are associated

with greater risk of adverse reactions.
Administration over less than 1 hour,
particularly in renal failure, has been
associated with hyperkalaemia and
arrhythmias
Paracetamol and parenteral pethidine

may alleviate rigors associated with
amphotericin administration. Can also
give antihistamines and corticosteroids 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
Amphotericin iV – Fungizone
t is not licensed for use by anyone else.
AMPhoTEriCin iV – FUnGiZonE 51

OTHER INFORMATION

*** AMPHOTERICIN IS HIGHLY
NEPHROTOXIC ***
Permanent renal impairment may

occur, particularly in patients receiving
conventional amphotericin B at doses
>1 mg/kg/day, or with pre-existing renal
impairment, prolonged therapy, sodium
depletion or concurrent nephrotoxic drugs
Nephrotoxicity may be reduced by

giving an

IV infusion

of sodium chloride
0.9% 250–500 mL over 30–45 minutes
immediately before administering
amphotericin B
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 20–30 minutes then stop
and observe for 30 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
There are reports of the use of

amphotericin in 20% lipid solution
being as well tolerated as liposomal
amphotericin