Amphotericin B
AMBISOME
What it isPolyene binding fungal ergosterol and forming membrane pores; severe systemic mycoses.
Why this oneThe broadest antifungal spectrum available and a mainstay for cryptococcal meningitis and mucormycosis.
What limits it⚑ Liposomal and deoxycholate formulations are not interchangeable; product errors can be fatal. Nephrotoxicity and infusion reactions dominate.
FDA-approved for
- systemic fungal infections (~1958)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Empirical therapy (presumed fungal infection in febrile neutropenia) | Adult/Pediatric | 3 mg/kg/day IV | ||
| Systemic fungal infections (Aspergillus, Candida, Cryptococcus) | Adult/Pediatric | 3-5 mg/kg/day IV | ||
| Cryptococcal meningitis in HIV-infected patients | Adult/Pediatric | 6 mg/kg/day IV | ||
| Visceral leishmaniasis (immunocompetent) | Adult/Pediatric | 3 mg/kg/day IV on days 1-5, 14, and 21 | ||
| Visceral leishmaniasis (immunocompromised) | Adult/Pediatric | 4 mg/kg/day IV on days 1-5, 10, 17, 24, 31, and 38 |
Renal Undefined
Hepatic Undefined
Instructions
- IV infusion over ~120 min via controlled infusion device; may reduce to ~60 min if well tolerated
- Flush existing IV line with 5% Dextrose before infusion, or use a separate line
- In-line filter mean pore diameter must be >=1.0 micron
- Reconstitute with Sterile Water for Injection (no bacteriostatic agent)
Cautions
- Infusion-related reactions (chills/rigors, fever)
- Nephrotoxicity / decreased kidney function
- Hypokalemia and hypomagnesemia
Adverse reactions
- Chills/rigors
- Fever
- Hypokalemia
- Hypomagnesemia
- Peripheral edema
- Nausea/vomiting
- Hypertension/hypotension, tachycardia
- Increased creatinine (nephrotoxicity)
Pregnancy No adequate and well-controlled studies in pregnant women; systemic fungal infections have been successfully treated in pregnancy with amphotericin B deoxycholate.
Lactation Undefined
⚠ BOXED WARNING
- Verify the product name and dosage; overdose can be fatal
Cost, est. cash$10–$500/month
Generic entry1987
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilitySevere nephrotoxicity, electrolyte wasting and infusion reactions require intensive monitoring.
Mechanism of action: Amphotericin B ballicule
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Memory aids: mascots and interaction avatars
antifungal
nephrotoxic
Bananas dispersing → ↓ serum potassium
