The lipid formulation of amphotericin B known as Ambisome (liposomal amphotericin B) is recommended for the treatment of severe fungi infections.

AmBisome (Liposomal amphotericin B) Uses:

• Cryptococcal meningitis in HIV-infected patients:

  • Treatment of cryptococcal meningitis in patients who are HIV-infected.

• Empiric therapy in fungal infections:

  • As Empiric treatment in febrile neutropenic patients suffering from presumed fungal infection.

• Fungal infections, systemic therapy:

  • Patients who are resistant to standard amphotericin B deoxycholate or who cannot take the deoxycholate formulation due to renal impairment or unacceptable toxicity may have systemic infections brought on by Aspergillus species, Candida species, and/or Cryptococcus species.

• Visceral Leishmaniasis:

  • Treatment Visceral leishmaniasis.

• Off Label Use of amBisome (Liposomal Amphotericin B) in Adults:

  • Candidiasis, empiric therapy (non-neutropenic ICU patients)
  • Coccidioidomycosis in HIV patients
  • Fungal meningitis (secondary to contaminated [eg, Exserohilum rostratum] steroid products)
  • Fungal osteoarticular infections (secondary to contaminated [eg, Exserohilum rostratum] steroid products)
  • Histoplasmosis in HIV patients
  • Cutaneous and mucosal Leishmaniasis
  • Cutaneous leishmaniasis in HIV patients
  • Visceral Leishmaniasis in HIV patients
  • Talaromyces marneffei infection in HIV patients

AmBisome (Liposomal amphotericin B) Dose in Adults

Note:

• Lipid-based amphotericin formulations, such as AmBisome, could be confused with more traditional ones, such as desoxycholate [Amphocin,
• Fungizone], or with other lipid-based amphotericin formulations (amphotericin B lipid complex [Abelcet], amphotericin B cholesteryl sulphate complex [Amphotec]).
• Lipid-based and traditional formulations have distinct doses and cannot be used interchangeably.
• When conventional formulations were unintentionally dispensed for lipid-based medicines, overdoses have been reported.

Usual dosage range: IV: 3 to 6 mg/kg/day Note:

• Premedication:
  • For patients who develop non-anaphylactic immediate infusion-related reactions, premedicate with nonsteroidal anti-inflammatory agent ± diphenhydramine; or
  • acetaminophen with diphenhydramine; or
  • hydrocortisone 30 to 60 minutes prior to drug administration:
  • Meperidine may be administered, if the patient experiences rigors during the infusion.

Indication-specific dosing:

amBisome dose as alternative therapy in the Aspergillus (systemic infection) (off-label):

• 3 to 5 mg/kg/day.
• doses up to 7.5 mg/kg/day have been recommended for CNS infection.
• The minimum duration of treatment is 6 to 12 weeks and depending upon the site of infection, the severity of the disease, and the level/duration of immunosuppression.

Note: Guidelines recommend amphotericin B lipid formulations should be considered for invasive aspergillosis in cases when triazoles, specifically voriconazole, are contraindicated or not tolerated.

amBisome dose in the  empiric therapy of Aspergillosis (off-label):

• 3 mg/kg/day.

Note: Guidelines recommend amphotericin B lipid formulations be considered for invasive aspergillosis in cases when triazoles, specifically voriconazole, are contraindicated or not tolerated.

amBisome dose in the treatment of Candidiasis:

• Candidemia (non-neutropenic patients) (alternative agent):

  • 3 to 5 mg/kg/day; may shift to fluconazole (usually after 5 to 7 days) in clinically stable patients, with fluconazole-susceptible isolates, and on negative repeat cultures.
  • After confirmed evidence of Candida from the bloodstream and the elimination of symptoms associated with candidemia in patients without complications from metastatic disease, the entire period of antifungal medication is at least two weeks.

• Candidemia (neutropenic patients) (alternative agent):

  • 3 to 5 mg/kg/day; may shift to fluconazole during persistent low Absolute neutrophil count in clinically stable patients, with fluconazole-susceptible isolates and negative repeat cultures.
  • Following the verified removal of Candida from the bloodstream and the remission of neutropenia and symptoms related to candidemia in patients without metastatic consequences, the total length of antifungal medication is at least two weeks.

• The central nervous system (eg, meningitis):

  • 5 mg/kg/day (with or without oral flucytosine);
  • step-down to fluconazole therapy is advised after initial response to treatment.

• Chronic disseminated (hepatosplenic):

  • 3 to 5 mg/kg/day;
  • after several weeks, changing to oral fluconazole in clinically stable, fluconazole-susceptible patients.

• Empiric therapy in suspected invasive candidiasis (non-neutropenic ICU patients) (alternative agent):

  • 3 to 5 mg/kg/day; in patients who show clinical and subjective improvement, treatment should last for 14 days. If there is no clinical improvement after 4 to 5 days, think about stopping treatment.

• Endocarditis (native or prosthetic valve) or infected implantable cardiac devices (eg, pacemaker, ICD, VAD):

  • 3 to 5 mg/kg/day (with or without flucytosine);
  • for native or prosthetic valve endocarditis, therapy should be continued for at least 6 weeks post valve replacement surgery (longer durations in patients with abscesses or other complications);
  • for patients with implantable cardiac devices, therapy should be continued for 4 to 6 weeks post-surgery (4 for infections limited to generator pockets and at least 6 weeks for infections involving the wires).

Note:

• May transition to fluconazole if the patient is clinically stable with fluconazole-susceptible isolates and Candida has been cleared from the bloodstream;
• chronic or long-term suppression with fluconazole may be needed (eg, prosthetic valve, valve replacement not possible).

• Endophthalmitis (with or without vitritis) caused by fluconazole- or voriconazole-resistant isolates:

  • 3 to 5 mg/kg/day (with or without flucytosine) for at least 4 to 6 weeks until examination indicates resolution;
  • for patients with vitritis or with macular involvement (with or without vitritis), an intravitreal injection of voriconazole or amphotericin B deoxycholate is also recommended.

• Intra-abdominal candidiasis (alternative agent):

  • 3 to 5 mg/kg/day; duration of therapy depends upon clinical response and source control.

• Osteomyelitis or septic arthritis due to Candida (alternative agent):

  • 3 to 5 mg/kg/day for at least 14 days, followed by fluconazole.

• Suppurative thrombophlebitis:

  • 3 to 5 mg/kg/day; continue for at least 14 days after candidemia has cleared; consider switching to fluconazole in clinically stable patients with a fluconazole-susceptible isolate who have responded to initial therapy.

• Manufacturer’s labeling:

  • The dosage listed in the prescribed material might not be accurate for the time..
    • Empiric therapy: 3 mg/kg/day;
    • Invasive infection: 3 to 5 mg/kg/day.

amBisome dose in the treatment of Coccidioidomycosis in HIV-infected patients (off-label):

• Serious infection not of the CNS (i.e. diffuse pulmonary or severely ill with the extrathoracic or disseminated disease):

  • 3 to 5 mg/kg/day until clinical improvement, then start triazole therapy (eg, fluconazole or itraconazole).

amBisome dose in the treatment of Cryptococcosis:

• Disseminated cryptococcosis (non-CNS or severe pulmonary disease) in HIV-infected patients:

  • IV: 3 to 4 mg/kg/day with flucytosine (preferred) or fluconazole, or without a concomitant agent.

• Meningitis in HIV-infected patients:

  • 3 to 4 mg/kg/day with flucytosine (preferred) or fluconazole, or without a concomitant agent.
  • Meningoencephalitis has been treated with doses up to 6 mg/kg/dose, which may be recommended in cases of treatment failure or severe fungal load disease.

• Manufacturer’s labeling:

  • Dosing in the prescribing information may not reflect current clinical practice. 6 mg/kg/day.

amBisome dose in the treatment of fungal sinusitis:

• Limited data in immunosuppressed patients have shown efficacy with 3 to 10 mg/kg/day.

Note: An azole antifungal is recommended if the causative organism is Aspergillus spp or Pseudallescheria boydii (Scedosporium sp).

amBisome dose in the treatment of Histoplasmosis in HIV-infected patients:

• moderately severe to severe disseminated disease:

  • Induction therapy: 3 mg/kg/day for at least two weeks, then maintenance therapy with oral itraconazole

• Histoplasma meningitis:

  • Induction therapy: 5 mg/kg/day for 4 to 6 weeks, then maintenance therapy with oral itraconazole

amBisome dose in the treatment of cutaneous leishmaniasis:

• IV: 3 mg/kg/day for the first five days, and then 10 days.
• on days 1 through 7.
• The total dose administered should be 18 to 21 mg/kg.

amBisome dose in the treatment of cutaneous Leishmaniasis in HIV-infected patients:

• 10 days of 2 to 4 mg/kg/day, or an irregular schedule (for instance, 4 mg/kg on days 1 through 5, then on days 10, 17, 24, 31, and 38).
• Total dose given should be 20 to 60 mg/kg.

amBisome dose in the treatment of mucosal Leishmaniasis:

• 3 mg/kg/day IV for a dosage of roughly 20 to 60 mg/kg overall.

amBisome Dose in the treatment of visceral Leishmaniasis:

• Immunocompetent:

  • In patients who don't get rid of the parasites, a second course may be given. The dosage is 3 mg/kg/day on days 1 through 5 and 3 mg/kg/day on days 14 and 21.

• Immunocompromised:

  • On days 1 through 5, as well as on days 10, 17, 24, 31, and 38, the dosage is 4 mg/kg/day.

amBisome Dose in the treatment of visceral leishmaniasis in HIV-infected patients:

• Treatment:

  • 2 to 4 mg/kg/day or
  • A  regimen that is broken up (for instance, 4 mg/kg on days 1 through 5 and then on days 10, 17, 24, and 31).
  • Total dose administered: 20 to 60 mg/kg

• Chronic maintenance therapy (for patients with a CD4 count <200 cells/mm³):

  • 4 mg/kg every 2 to 4 weeks

amBisome Dose in the treatment of Severe Meningitis (secondary to contaminated [eg, Exserohilum rostratum] steroid products) or in patients not improving with voriconazole monotherapy (off-label):

• IV: 5 to 6 mg/kg/day in combination with voriconazole for ≥3 months; a higher dose (7.5 mg/kg/day) may be considered in patients who are not

Note: Consult an infectious disease specialist and current CDC guidelines for specific treatment recommendations.

amBisome Dose in the treatment of severe Osteoarticular infection (secondary to contaminated e.g., Exserohilum rostratum) steroid products:

• IV: 5 mg/kg/day in combination with voriconazole for ≥3 months.

Note: Take the opinion of an infectious disease specialist and current CDC guidelines for specific treatment recommendations.

amBisome Dose in the treatment of Talaromyces marneffei infection in HIV-infected patients (off-label):

• 3 to 5 mg/kg/day for 2 weeks, followed by oral itraconazole for 10 weeks, followed by chronic maintenance therapy

AmBisome (Liposomal amphotericin B) Dose in Children

• Mistaking lipid-based amphotericin (Abelcet, Amphotec, and AmBisome) for regular amphotericin B for injection has been linked to medication errors, including fatalities.
• The recommended dosage for lipid-based and traditional formulations differs and cannot be used interchangeably.
• When conventional formulations were unintentionally delivered for lipid-based medicines, overdoses have happened.

Note:

• Premedicating: For patients who have non-anaphylactic acute reactions to an infusion, take one of the following medications 30 to 60 minutes before administering the medication: acetaminophen with diphenhydramine or hydrocortisone, or NSAID (with or without diphenhydramine).
• Meperidine may be given if the patient develops rigours during the infusion.

amBisome (Liposomal amphotericin B) General dosing:

• Empiric therapy:

  • Infants, Children, and Adolescents:

    • IV: 3 mg/kg/dose once a day

• Treatment, susceptible systemic infection:

  • Infants, Children, and Adolescents:

    • IV: 3 to 5 mg/kg/dose once a day

amBisome (Liposomal amphotericin B) dose in the treatment of Aspergillosis:

• Invasive:

  • Infants, Children, and Adolescents:

    • IV: 3 to 5 mg/kg/dose once a day.

• Endocarditis:

  • Children and Adolescents:

    • IV: 3 to 5 mg/kg/dose once a day with or without flucytosine.

amBisome (Liposomal amphotericin B) dose in the treatment of invasive Blastomycosis:

• Infants, Children, and Adolescents:

  • IV: 3 to 5 mg/kg/dose once a day for initial therapy,
  • If there is a CNS infection, 4 to 6 weeks of treatment may be necessary, followed by 12 months of oral itraconazole.

amBisome (Liposomal amphotericin B) dose in the treatment of Candidiasis:

• Invasive (Independent of HIV status):

  • Infant, Children, and Adolescents:

    • IV: 3 to 5 mg/kg/dose once a day.
    • Note: Patients who are HIV-exposed or positive may be given doses at the upper end of the range (5 mg/kg/day).

• CNS infection:

  • Infants, Children, and Adolescents:

    • IV: Once daily, 5 mg/kg/dose, with or without flucytosine

• Endocarditis:

  • Infants, Children, and Adolescents:

    • IV: One dose of 3 to 5 mg/kg/day, with or without flucytosine

• Esophageal:

  • HIV-exposed/-positive:

    • Adolescents:

      • IV: 3–4 mg/kg/dose given once daily for 14–21 days.

amBisome (Liposomal amphotericin B) dose in the treatment of invasive Coccidioidomycosis:

• Non-HIV-exposed/ HIV-positive:

  • Disseminated infection, non-pulmonary:

    • Infants, Children, and Adolescents:

      • IV: 2 to 5 mg/kg/dose once a day with or without concomitant azole antifungal.

  • Diffuse Pulmonary infection:

    • Infants, Children, and Adolescents:

      • IV: 2 to 5 mg/kg/dose given once daily for a few weeks, then an oral azole antifungal for a total of 12 months of treatment.

• HIV-exposed/ HIV-positive:

  • Severe non-CNS infection (ie, diffuse pulmonary or severely ill with extrathoracic disseminated disease):

    • Infants and Children:

      • IV: 5 mg/kg/dose once a day until clinical improvement (minimum of several weeks of therapy), then initiate triazole therapy (eg, fluconazole or itraconazole);
      • For infections that are life-threatening, the dose can be increased to as much as 10 mg/kg/dose once daily.

    • Adolescents:

      • IV: 3 to 5 mg/kg/dose once a day until clinical improvement, then switch to fluconazole or itraconazole.

amBisome (Liposomal amphotericin B) dose in the treatment of invasive cryptococcosis:

• Disseminated cryptococcosis (non-CNS or severe pulmonary disease):

  • Infants and Children (independent of HIV status):

    • IV: 3 to 5 mg/kg/dose once a day with oral flucytosine;
    • if flucytosine unavailable or not tolerated may administer alone or in combination with high-dose fluconazole in HIV-exposed/-positive patients.

  • Adolescents:

    • Non-HIV-exposed/-positive:

      • IV: once day for at least 14 days, 3 to 4 mg/kg
      • may consider the addition of oral flucytosine.

    • HIV-exposed/-positive:

      • IV: Once daily dose of 3 to 4 mg/kg with or without flucytosine or fluconazole

amBisome (Liposomal amphotericin B) dose in the treatment of Meningitis:

• Non-HIV-exposed/ HIV-positive:

  • Infants, Children, and Adolescents:

    • IV: 5 mg/kg/dose once a day with flucytosine.

• HIV-exposed/ HIV-positive:

  • Manufacturer’s labeling:

    • Infants, Children, and Adolescents:

      • IV: 6 mg/kg/dose once a day

  • Alternate dosing:

    • Infants and Children:

      • IV: 6 mg/kg/dose once a day with or without oral flucytosine or high dose fluconazole for a minimum 2-week induction;

    • Note:

      • minimum two-week induction, consolidation, and long-term suppressive therapy
      • a longer duration of induction therapy may be necessary if CSF is not negative or lack of clinical improvement.

    • Adolescents:

      • IV: 3 to 4 mg/kg/dose once a day with or without oral flucytosine or fluconazole.
      • Meningoencephalitis has been treated with doses up to 6 mg/kg/dose, which may be used in cases of treatment failure or severe fungal load illness.

amBisome (Liposomal amphotericin B) dose in the empiric therapy of Febrile neutropenia:

• Infants, Children, and Adolescents:

  • IV: 3 mg/kg/dose once daily.

amBisome (Liposomal amphotericin B) dose in the treatment of Histoplasmosis:

• Non-HIV-exposed or HIV-positive:

  • Acute pulmonary disease or disseminated (non-CNS):

    • Infants, Children, and Adolescents:

      • IV: Itraconazole orally for a total of 12 weeks after receiving a dose of 3 mg/kg once daily for 1 to 2 weeks; traditional amphotericin B is often preferable.

• HIV-exposed/-positive:

  • Disseminated infection (non-CNS disease):

    • Infants and Children:

      • IV: 3 to 5 mg/kg/dose once a day for at least 2 weeks for induction;
      • if itraconazole not tolerated for consolidation therapy may continue for 4 to 6 weeks.

    • Adolescents:

      • IV: For induction, take 3 mg/kg once a day for at least two weeks.

  • CNS disease:

    • Infants, Children, and Adolescents:

      • IV: Once daily for 4 to 6 weeks, 5 mg/kg/dose for induction, then consolidation therapy.

amBisome (Liposomal amphotericin B) dose in the treatment of Leishmaniasis:

• Visceral infection, treatment:

  • Immunocompetent patients:

    • Infants, Children, and Adolescents:

      • IV: Initial: On days 1 through 5, 3 mg/kg/dose was given once daily; on days 14 and 21, 3 mg/kg/dose was given.

Note: Patients who do not clear their parasites may receive a repeat round.

• Immunocompromised patients:

  • Infants, Children, and Adolescents:

    • IV: Initial: On days 1 through 5 and on days 10, 17, 24, 31, and 38, administer a dosage of 4 mg/kg once daily.

• HIV-exposed/-positive:

  • Treatment:

    • Adolescents:

      • IV: 2 to 4 mg/kg/dose given once daily, or 4 mg/kg/dose given on days 1 to 5, 10, 17, 24, 31, and 38, for a total dose of 20 to 60 mg/kg.

  • Chronic maintenance therapy:

    • Adolescents:

      • IV: 4 mg/kg per dosage, every two to four weeks;
      • Note: use is only permitted in those with visceral infections and CD4 counts lower than 200 cells/mm.

amBisome (Liposomal amphotericin B) dose in the treatment of cutaneous infection in HIV-exposed/-positive:

• Adolescents:

  • For a total dose of 20–60 mg/kg, administer 2–4 mg/kg/dose IV once day for 10 days, or administer 4 mg/kg/dose on Days 1–5, 10, 17, 24, 31, and 38.

amBisome (Liposomal amphotericin B) Dose in the treatment of Sporotrichosis infection:

• Disseminated, pulmonary, or osteoarticular disease:

  • Adolescents:

    • 3 to 5 mg/kg/dose IV once a day, followed by oral itraconazole after a favorable response is seen with amphotericin initial therapy

• Meningeal:

  • Adolescents:

    • • 5 mg/kg/dose IV once a day for 4 to 6 weeks, followed by oral itraconazole

Pregnancy Risk Factor B

• In animal reproduction studies, adverse events were not reported.
• Amphotericin crosses over the placenta to enter the fetal circulation.
• For serious systemic fungal diseases, pregnant women should be treated with amphotericin B.

Liposomal Amphotericin B Use during Breast-Feeding:

• If amphotericin has been excreted from breast milk, there is no data.
• Infants who are nursing are likely to experience relatively little systemic exposure due to its limited oral absorption.
• The danger of harmful effects makes breastfeeding not recommended by the manufacturer.

amBisome (liposomal amphotericin B dose in Kidney Disease:

The manufacturer's labelling does not mention dosage changes, however it has been successfully given to individuals who already had renal impairment.

• End-stage renal disease (ESRD) on intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days):

  • It is poorly dialyzed;
  • No dosage adjustment necessary

• CVVH/CVVHD/CVVHDF:

  • No dosage adjustment necessary

amBisome dose in Liver disease:

The manufacturer's labelling does not mention dosage modifications (has not been studied).

Common Side Effects of amBisome (Liposomal Amphotericin B):

• Cardiovascular:

  • Hypertension
  • Tachycardia
  • Peripheral Edema
  • Edema
  • Hypotension
  • Chest Pain
  • Localized Phlebitis

• Central Nervous System:

  • Chills
  • Insomnia
  • Headache
  • Pain
  • Anxiety
  • Confusion

• Dermatologic:

  • Skin Rash
  • Pruritus

• Endocrine & Metabolic:

  • Hypokalemia
  • Hypomagnesemia
  • Hyperglycemia
  • Hypocalcemia
  • Hyponatremia
  • Hypervolemia

• Gastrointestinal:

  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal Pain
  • Constipation
  • Anorexia

• Genitourinary:

  • Nephrotoxicity
  • Hematuria

• Hematologic & Oncologic:

  • Anemia
  • Leukopenia
  • Thrombocytopenia

• Hepatic:

  • Increased Serum Alkaline Phosphatase
  • Hyperbilirubinemia
  • Increased Serum ALT
  • Increased Serum AST
  • Abnormal Hepatic Function Tests

• Hypersensitivity:

  • Transfusion Reaction

• Infection:

  • Sepsis
  • Infection

• Neuromuscular & Skeletal:

  • Weakness
  • Back Pain

• Renal:

  • Increased Serum Creatinine
  • Increased Blood Urea Nitrogen

• Respiratory:

  • Dyspnea
  • Pulmonary Disease
  • Cough
  • Epistaxis
  • Pleural Effusion
  • Rhinitis

• Miscellaneous:

  • Infusion Related Reactions

Less Common Side Effects of amBisome (Liposomal Amphotericin B):

• Cardiovascular:

  • Atrial Fibrillation
  • Bradycardia
  • Cardiac Arrest
  • Cardiac Arrhythmia
  • Cardiomegaly
  • Facial Edema
  • Flushing
  • Heart Valve Disease
  • Orthostatic Hypotension
  • Vascular Disorder
  • Vasodilatation

• Central Nervous System:

  • Dizziness
  • Abnormality In Thinking
  • Agitation
  • Coma
  • Depression
  • Drowsiness
  • Dysesthesia
  • Dystonia
  • Hallucination
  • Malaise
  • Nervousness
  • Paresthesia
  • Rigors
  • Seizure

• Dermatologic:

  • Diaphoresis
  • Alopecia
  • Cellulitis
  • Dermal Ulcer
  • Dermatological Reaction
  • Maculopapular Rash
  • Skin Discoloration
  • Urticaria
  • Vesiculobullous Dermatitis
  • Xeroderma

• Endocrine & Metabolic:

  • Hypernatremia
  • Acidosis
  • Hyperchloremia
  • Hyperkalemia
  • Hypermagnesemia
  • Hyperphosphatemia
  • Hypophosphatemia
  • Increased Lactate Dehydrogenase
  • Increased Nonprotein Nitrogen

• Gastrointestinal:

  • Gastrointestinal Hemorrhage
  • Aphthous Stomatitis
  • Dyspepsia
  • Dysphagia
  • Enlargement Of Abdomen
  • Eructation
  • Fecal Incontinence
  • Flatulence
  • Gingival Hemorrhage
  • Hematemesis
  • Hemorrhoids
  • Hiccups
  • Increased Serum Amylase
  • Intestinal Obstruction
  • Mucositis
  • Rectal Disease
  • Stomatitis
  • Xerostomia

• Genitourinary:

  • Dysuria
  • Toxic Nephrosis
  • Urinary incontence
  • Vaginal Hemorrhage

• Hematologic & Oncologic:

  • Blood Coagulation Disorder
  • Bruise
  • Decreased Prothrombin Time
  • Hemophthalmos
  • Hemorrhage
  • Hypoproteinemia
  • Increased Prothrombin Time
  • Oral Hemorrhage
  • Petechia
  • Purpura

• Hepatic:

  • Hepatic Injury
  • Hepatic Sinusoidal Obstruction Syndrome (Formerly Known As Hepatic Veno-Occlusive Disease)
  • Hepatomegaly

• Hypersensitivity:

  • Delayed Hypersensitivity
  • Hypersensitivity Reaction

• Immunologic:

  • Graft Versus Host Disease

• Infection:

  • Herpes Simplex Infection

• Local:

  • Inflammation At Injection Site

• Neuromuscular & Skeletal:

  • Arthralgia
  • Myalgia
  • Neck Pain
  • Ostealgia
  • Tremor

• Ophthalmic:

  • Conjunctivitis
  • Dry Eyes

• Renal:

  • Acute Renal Failure
  • Renal Failure
  • Renal Function Abnormality

• Respiratory:

  • Hypoxia
  • Asthma
  • Atelectasis
  • Dry Nose
  • Flu-Like Symptoms
  • Hemoptysis
  • Hyperventilation
  • Pharyngitis
  • Pneumonia
  • Pulmonary Edema
  • Respiratory Alkalosis
  • Respiratory Failure
  • Respiratory Insufficiency
  • Sinusitis

• Miscellaneous:

  • Procedural Complication

Contraindications to amBisome (Liposomal Amphotericin B):

Hypersensitivity to amphotericinB deoxycholate and any component of the formulation

Warnings and precautions

• Anaphylaxis

  • According to reports, the event included medications that contained amphotericin B.
    • Due to the possibility that anaphylactic reactions may occur, it is important that cardiopulmonary resuscitation facilities are available at all times.
  • If severe anaphylactic reactions occur,
    • The infusion needs to be discontinued right away.
    • No more infusions should be given to the patient.
  • When administering the first dose, do it under strict clinical supervision.

• Infusion reactions

  • Within 1 to 3 hours after beginning an infusion, acute responses, including fever and chills, may occur. The frequency of these events increases in the first few doses but normally declines with additional doses.
  • If severe anaphylactic reactions occur, stop infusion immediately. The patient should not be given any further infusions.

• Heart failure:

  • According to the American Heart Association's scientific statement, amphotericin is a substance that can cause myocardial damage (magnitude: major/moderate).

Liposomal amphotericin B: Drug Interaction

Monitoring parameters:

• Renal function (monitor frequently during therapy),
• electrolytes (especially potassium and magnesium),
• liver function tests,
• temperature,
• hematocrit,
• PT/PTT,
• CBC;
• monitor input and output;
• monitor for signs of hypokalemia (muscle weakness, cramping, drowsiness, ECG changes, etc);
• monitor cardiac function if used concurrently with corticosteroids

How to administer amBisome (Liposomal Amphotericin B)?

• Use an intravenous infusion to administer the medication over the course of around two hours.
• In patients whose treatment is well tolerated, the infusion time may be reduced to roughly one hour.
• The infusion's duration could be extended if the patient encounters any issues.
• Before and after an infusion, an existing intravenous line needs to be flushed with D/W. (if not feasible, administer through a separate line).
• You might use an in-line membrane filter with a minimum pore size of 1 micron.
• Pre-medicate with the following medicines 30 to 60 minutes before the administration of the medication in case the patient exhibits chills, fever, hypotension, nausea, or other non-anaphylactic acute infusion-related reactions:
  • ibuprofen, choline magnesium trisalicylate, or acetaminophen plus diphenhydramine or hydrocortisone are examples of nonsteroidal anti-inflammatory drugs.
• Meperidine may be given if the patient develops rigours during the infusion.

Mechanism of Action of Ambisme (Liposomal Amphotericin B):

• Binds to ergosterol, changing the permeability of cell membranes for fungi that are vulnerable, and inducing cell death by allowing cell components to escape.
• According to the proposed mechanism, amphotericin stimulates macrophages through an oxidation-dependent process.

Notice:

Greater than proportional increase in serum concentration with increasing dose in nonlinear kinetics

Half-life elimination:

• After a single 24-hour dosing interval, the half-life is 7 to 10 hours; the terminal half-life is 100 to 153 hours (following multiple dosing up to 49 days)

International Brands of Liposomal Amphotericin B:

• AmBisome
• Ambisome
• Amfostat
• Amphotec
• Fengkesong

Liposomal Amphotericin B Brand Names in Pakistan:

No brands available in Pakistan