AMPHOTERICIN B (am-foe-ter'i-sin) Amphocin, Fungizone AMPHOTERICIN B LIPID-BASED Abelcet, Amphotec, AmBisome Classifications: antiinfective; antifungal antibiotic Pregnancy Category: B |
Abelcet 100 mg/20 mL suspension for injection
Amphotec 50 mg, 100 mg powder for injection
AmBisome 50 mg powder for injection
Fungizone 50 mg powder for injection; 100 mg/mL suspension; 3% cream, lotion, ointment
Fungistatic antibiotic produced by Streptomyces nodosus. Fungicidal at higher concentrations, depending on sensitivity of fungus.
Exerts antifungal action on both resting and growing cells at least in part by selectively binding to sterols in fungus cell membrane.
Used intravenously for a wide spectrum of potentially fatal systemic fungal (mycotic) infections including aspergillosis, blastomycosis, coccidioidomycosis, cryptococcosis, disseminated candidiasis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and others. Has been used to potentiate antifungal effects of flucytosine (Ancobon) and to provide anticandidal prophylaxis in certain susceptible patients receiving immunosuppressive therapy. Used topically for cutaneous and mucocutaneous infections caused by Candida (monilia). Abelcet: aspergillosis.
Treatment of candiduria, fungal endocarditis, meningitis, septicemia; fungal infections of urinary bladder and urinary tract; amebic meningoencephalitis, and paracoccidioidomycosis.
Hypersensitivity to amphotericin.
Severe bone marrow depression or renal function impairment. Safety during pregnancy (category B) or lactation is not established.
Systemic Infections [Amphocin, Fungizone] Adult: IV Test Dose 1 mg dissolved in 20 mL of D5W by slow infusion (over 1030 min) IV Maintenance Dose 0.250.3 mg/kg/day infused over 46 h, may gradually increase by 0.50.75 mg/kg/d up to 11.5 mg/kg/d Child: IV Test Dose 0.1 mg/kg up to 1 mg dissolved in 20 mL of D5W by slow infusion (over 1030 min) IV Maintenance Dose 0.4 mg/kg/d infused over 46 h, may increase by 0.25 mg/kg/d to target dose of 0.251 mg/kg/d infused over 26 h [Abelcet] Adult/Child: IV 35 mg/kg/d infused at 2.5 mg/kg/h [Amphotec] Adult/Child: IV Test Dose 10 mL (1.68.3 mg) of initial dose infused over 1030 min IV Maintenance Dose 34 mg/kg/d (max: 7.5 mg/kg/d) infused at 1 mg/kg/h [AmBisome] Adult/Child: IV 35 mg/kg/d infused over 12 h Cryptococcal Meningitis in HIV [AmBisome] Adult: IV 6 mg/kg/d infused over 2 h Candiduria [Amphocin, Fungizone] Adult: Irrigation 550 mg/1000 mL sterile water instilled continuously into the bladder via a 3-way closed drainage catheter system at a rate of 1000 mL/24 h Oral Candidiasis [Fungizone] Adult/Child: PO 100 mg swish & swallow q.i.d. Cutaneous Candidiasis [Fungizone] Adult/Child/Infant: Topical apply to lesions 24 times/d for 14 wks |
Intravenous PREPARE: Each brand of amphotericin is prepared differently according to manufacturer's directions. Refer to specific manufacturer's guidelines for preparation of IV solutions. ADMINISTER: Abelcet Intermittent: • Flush existing IV line with D5W before infusion.• Use 5 micron in-line filter. Infuse total daily dose at 2.5 mg/kg/h.• Shake IV bag at least q2h to evenly mix solution. Amphotec Intermittent: • Do not use an in-line filter.• Infuse total daily dose at 1 mg/kg/h. Infusion time may be shortened but should never be <2 h. Infusion time may also be extended for better tolerance. AmBisome Intermittent: • Do not use an in-line filter.• Infuse total daily dose over 2 h. Infusion time may be shortened but should never be <1 h. Fungizone Intermittent: • Use a 1-micron filter.• Infuse total daily dose over 26 h. Use longer infusion time for better tolerance.• Alert: Rapid infusion of any amphotericin can cause cardiovascular collapse. If hypotension or arrhythmias develop interrupt infusion and notify physician.• Protect IV solution from light during administration.• Note incompatibilities. When given through an existing IV line, flush before and after with D5W.• Initiate therapy using the most distal vein possible and alternate sites with each dose if possible to reduce the risk of thrombophlebitis.• Check IV site frequently for patency. INCOMPATIBILITIES Solution/additive: Any saline-containing solution (precipitate will form), parenteral nutrition solutions, calcium chloride, calcium gluconate, cimetidine, edetate calcium disodium, metaraminol, methyldopa, polymyxin, potassium chloride, ranitidine, verapamil. Y-site: aminoglycosides, penicillins, phenothiazines, clindamycin, cotrimoxazole, diphenhydramine, dopamine, dobutamine, heparin (flush lines with D5W, not NS), lidocaine, procaine, tetracycline, fluconazole, vitamins, TPN. Do not mix Abelcet or Amphotec with any other drugs. |
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