{"id":1635,"date":"2023-06-25T17:28:42","date_gmt":"2023-06-25T17:28:42","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/amphotericin\/"},"modified":"2023-06-25T19:58:42","modified_gmt":"2023-06-25T19:58:42","slug":"amphotericin","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/amphotericin\/","title":{"rendered":"Amphotericin"},"content":{"rendered":"

<\/p>\n

Amphotericin<\/h1>\n

CLINICAL USE<\/h3>\n

Antifungal agent:<\/p>\n

  • Systemic fungal infections (yeasts andyeast-like fungi including Candida
    \nalbicans<\/p>\n

    DOSE IN NORMAL RENAL FUNCTION<\/h3>\n

    5 mg\/kg\/day for at least 14 days (see
    \nindividual product data sheet)<\/p>\n

    PHARMACOKINETICS<\/h3>\n<\/li>\n
  • Molecular weight                           :
    \n924.1<\/li>\n
  • %Protein binding                           :
    \n90<\/li>\n
  • %Excreted unchanged in urine     :
    \n<1<\/li>\n
  • Volume of distribution (L\/kg)       :
    \n2286<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      :
    \n173.4\/Unchanged<\/p>\n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n<\/li>\n
  • 20 to 50     : Dose as in normal renal function<\/li>\n
  • 10 to 20     : Dose as in normal renal function<\/li>\n
  • <10           :
    \nDose as in normal renal function<\/p>\n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                :
    \nNot dialysed. Dose as in normal renal function<\/li>\n
  • HD                     :
    \nNot dialysed. Dose as in normal renal function<\/li>\n
  • HDF\/high flux   :
    \nUnknown dialysability. Dose as in
    \nnormal renal function<\/li>\n
  • CAV\/VVHD      :
    \nNot dialysed. Dose as in normal renal function<\/p>\n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugs<\/li>\n

  • Ciclosporin: increased nephrotoxicity<\/li>\n
  • Tacrolimus: increased nephrotoxicity<\/li>\n
  • Increased risk of nephrotoxicity withaminoglycosides and other nephrotoxic
    \nagents and cytotoxics<\/li>\n
  • Cardiac glycosides: increased toxicity ifhypokalaemia occurs<\/li>\n
  • Corticosteroids: increased risk ofhypokalaemia (avoid concomitant use
    \nunless corticosteroids are required to
    \ncontrol reactions)<\/li>\n
  • Flucytosine: enhanced toxicity incombination with amphotericin
    \n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n

    See individual data sheet. Prepare<\/p>\n

    intermittent infusion in glucose 5%
    \n(incompatible with sodium chloride 0.9%,
    \nelectrolytes or other drugs).<\/li>\n

  • Dilute to a concentration of 1\u20132 mg\/mL
    \n

    Route<\/h4>\n

    IV infusion<\/h4>\n

    Rate of Administration<\/h4>\n

    2.5 mg\/kg\/hour<\/p>\n

    Comments<\/h4>\n<\/li>\n
  • Paracetamol and parenteral pethidinemay alleviate rigors associated with
    \namphotericin administration. Can also use
    \nantihistamines to control reactions<\/li>\n
  • Flush existing IV line with glucose 5%before and after infusion administration<\/li>\n
  • For patients on CAV\/VVHD, amphotericinshould be given into the venous return of
    \nthe dialysis circuit
    \nShould be given post dialysis<\/p>\n

    OTHER INFORMATION<\/h4>\n

    *** AMPHOTERICIN IS HIGHLY
    \nNEPHROTOXIC ***<\/li>\n

  • Can cause distal tubular acidosis<\/li>\n
  • May cause polyurea, hypovolaemia,hypokalaemia and acidosis.<\/li>\n
  • Amphotericin and flucytosine actsynergistically when co-administered
    \nenabling lower doses to be used effectively<\/li>\n
  • A test dose of amphotericin isrecommended at the beginning of a new
    \ncourse (1 mg over 15 minutes)<\/li>\n
  • Monitor renal function, full blood count,potassium, magnesium and calcium levels<\/li>\n
  • Liposomal amphotericin is considerablyless nephrotoxic compared with
    \nconventional amphotericin B, but is
    \nconsiderably more expensive<\/li>\n","protected":false},"excerpt":{"rendered":"

    Amphotericin CLINICAL USE Antifungal agent: Systemic fungal infections (yeasts andyeast-like<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-1635","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1635","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=1635"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1635\/revisions"}],"predecessor-version":[{"id":2930,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1635\/revisions\/2930"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=1635"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=1635"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=1635"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}