amphotericin B deoxycholate (Rx)

Brand and Other Names:amphotericin B (conventional)
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 50mg/vial

Systemic Fungal Infections

Test dose: 1 mg in 20 mL of 5% dextrose solution IV over 20-30 min; patient's temperature, pulse, respiration, and blood pressure should be recorded every 30 minutes for 2 to 4 hours

Loading dose in patients with well tolerated test dose and good cardio-renal function: 0.25 mg/kg IV qDay  

Severe and rapidly progressive fungal infection: 0.3 mg/kg IV qDay

Impaired cardio-renal function or severe reaction to test dose: Initiate therapy with smaller daily doses, ie, 5 - 10 mg

Maintenance: Depending on the patient's cardio-renal status, doses may gradually be increased by 5 to 10 mg per day to final daily dosage of 0.5 to 0.7 mg/kg

insufficient data available to define total dosage requirements and duration of treatment necessary for eradication of specific mycoses; optimal dose unknown; total daily dosage may range up to 1.0 mg/kg/day or up to 1.5 mg/kg when given on alternate days

Sporotrichosis: Length of therapy may range for up to 9 months with total dose of up to 2.5 g

Aspergillosis: Length of therapy may range for up to 11 months with total dose of up to 3.6 g

Renal Impairment

CrCl <10 mL/min: 0.5-0.7 mg/kg IV q24-48hr

Consider other antifungal agents that may be less nephrotoxic

Intermittent hemodialysis: 0.5-1 mg/kg IV q24hr after dialysis session

Continuous renal replacement therapy: 0.5-1 mg/kg IV q24hr

Other Indications & Uses

Aspergillosis, cryptococcosis, blastomycosis, systemic candidiasis, coccidioidomycosis, histoplasmosis, zygomycosis, sporotrichosis, leishmaniasis (not drug of choice)

Infections of Mucor, Rhizopus, Absidia, Conidiobolus, Basiobolus spp.

Off-label: amoebic meningoencephalitis (Naegleria fowleri); ocular aspergillosis; candidal cystitis; severe meningitis (intrathecal); coccidioidal arthritis (intra-articular or IM)

Dosage Forms & Strengths

powder for injection

  • 50mg/vial

Systemic Fungal Infections

Test dose: 0.1 mg/kg IV, not to exceed 1 mg; administer over 20-60 min  

Initial dose: 0.25 mg/kg/dose IV qDay/qOD

Maintenance: Increase by 0.25 mg/day increments as tolerated to 1-1.5 mg/kg/day

Candida auris (Off-label)

The CDC recommends amphotericin B deoxycholate as the initial treatment of choice for neonates and infants aged <2 months

1 mg/kg/day IV  

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Interactions

Interaction Checker

and amphotericin B deoxycholate

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (9)

            • amikacin

              amikacin and amphotericin B deoxycholate both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • cidofovir

              amphotericin B deoxycholate and cidofovir both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • contrast media (iodinated)

              amphotericin B deoxycholate and contrast media (iodinated) both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • cyclosporine

              amphotericin B deoxycholate and cyclosporine both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • ioversol

              amphotericin B deoxycholate and ioversol both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • neomycin PO

              amphotericin B deoxycholate and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • streptozocin

              amphotericin B deoxycholate and streptozocin both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • tacrolimus

              amphotericin B deoxycholate and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • teicoplanin

              amphotericin B deoxycholate and teicoplanin both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            Serious - Use Alternative (23)

            • acyclovir

              acyclovir and amphotericin B deoxycholate both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • atracurium

              amphotericin B deoxycholate increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • capreomycin

              amphotericin B deoxycholate and capreomycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • carboplatin

              amphotericin B deoxycholate and carboplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • cephaloridine

              amphotericin B deoxycholate and cephaloridine both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • cisatracurium

              amphotericin B deoxycholate increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • cisplatin

              amphotericin B deoxycholate and cisplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • colistin

              amphotericin B deoxycholate and colistin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • corticotropin

              amphotericin B deoxycholate, corticotropin. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Potential for hypokalemia.

            • digoxin

              amphotericin B deoxycholate increases effects of digoxin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Digoxin effects increased if hypokalemia results from Ampho B Tx.

            • gentamicin

              amphotericin B deoxycholate and gentamicin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • incobotulinumtoxinA

              amphotericin B deoxycholate increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • onabotulinumtoxinA

              amphotericin B deoxycholate increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • oxaliplatin

              amphotericin B deoxycholate and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • pancuronium

              amphotericin B deoxycholate increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • polymyxin B

              amphotericin B deoxycholate and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • rapacuronium

              amphotericin B deoxycholate increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • rimabotulinumtoxinB

              amphotericin B deoxycholate increases effects of rimabotulinumtoxinB by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • rocuronium

              amphotericin B deoxycholate increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • Saccharomyces boulardii

              amphotericin B deoxycholate decreases effects of Saccharomyces boulardii by unspecified interaction mechanism. Avoid or Use Alternate Drug. Systemic or oral antifungals may decrease activity of probiotic.

            • succinylcholine

              amphotericin B deoxycholate increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • tobramycin

              amphotericin B deoxycholate and tobramycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • vecuronium

              amphotericin B deoxycholate increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            Monitor Closely (31)

            • adefovir

              adefovir and amphotericin B deoxycholate both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • beclomethasone, inhaled

              beclomethasone, inhaled increases toxicity of amphotericin B deoxycholate by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Corticosteroids may increase the hypokalemic effect of amphotericin B.

            • benazepril

              amphotericin B deoxycholate, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • captopril

              amphotericin B deoxycholate, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • deflazacort

              amphotericin B deoxycholate and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • dichlorphenamide

              dichlorphenamide and amphotericin B deoxycholate both decrease serum potassium. Use Caution/Monitor.

              dichlorphenamide, amphotericin B deoxycholate. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              amphotericin B deoxycholate and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • foscarnet

              amphotericin B deoxycholate and foscarnet both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • ifosfamide

              ifosfamide increases toxicity of amphotericin B deoxycholate by unknown mechanism. Use Caution/Monitor. Monitor for possible increases in renal toxicity, bronchospasm, and hypotension if amphotericin is given concomitantly with ifosfamide.

            • lomustine

              lomustine increases toxicity of amphotericin B deoxycholate by unknown mechanism. Use Caution/Monitor. Monitor for possible increases in renal toxicity, bronchospasm, and hypotension if amphotericin is given concomitantly with lomustine.

            • mechlorethamine

              mechlorethamine increases toxicity of amphotericin B deoxycholate by unknown mechanism. Use Caution/Monitor. Monitor for possible increases in renal toxicity, bronchospasm, and hypotension if amphotericin is given concomitantly with mechlorethamine.

            • melphalan

              melphalan increases toxicity of amphotericin B deoxycholate by unknown mechanism. Use Caution/Monitor. Monitor for possible increases in renal toxicity, bronchospasm, and hypotension if amphotericin is given concomitantly with melphalan.

            • methoxyflurane

              amphotericin B deoxycholate and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • mometasone inhaled

              mometasone inhaled increases toxicity of amphotericin B deoxycholate by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may enhance the hypokalemic effect of amphtericin B. .

            • oxaliplatin

              oxaliplatin increases toxicity of amphotericin B deoxycholate by unknown mechanism. Use Caution/Monitor. Monitor for possible increases in renal toxicity, bronchospasm, and hypotension if amphotericin is given concomitantly with oxaliplatin.

            • paromomycin

              amphotericin B deoxycholate and paromomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • pentamidine

              amphotericin B deoxycholate and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • peramivir

              amphotericin B deoxycholate increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

            • rituximab

              amphotericin B deoxycholate and rituximab both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Caution should be exercised when concurrent therapy is used. Patients should be monitored for signs of renal failure.

            • rituximab-hyaluronidase

              amphotericin B deoxycholate and rituximab-hyaluronidase both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Caution should be exercised when concurrent therapy is used. Patients should be monitored for signs of renal failure.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of amphotericin B deoxycholate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of amphotericin B deoxycholate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              amphotericin B deoxycholate and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • streptomycin

              amphotericin B deoxycholate and streptomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • tenofovir DF

              amphotericin B deoxycholate and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Combination may also increase tenofovir levels.

            • tobramycin inhaled

              tobramycin inhaled and amphotericin B deoxycholate both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension and amphotericin B deoxycholate both decrease serum potassium. Use Caution/Monitor.

            • ustekinumab

              ustekinumab, amphotericin B deoxycholate. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • vancomycin

              amphotericin B deoxycholate and vancomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • voclosporin

              voclosporin, amphotericin B deoxycholate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • xipamide

              xipamide, amphotericin B deoxycholate. pharmacodynamic synergism. Use Caution/Monitor. Risk of hypokalemia.

            Minor (31)

            • amobarbital

              amobarbital decreases levels of amphotericin B deoxycholate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • budesonide

              amphotericin B deoxycholate, budesonide. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • butabarbital

              butabarbital decreases levels of amphotericin B deoxycholate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • butalbital

              butalbital decreases levels of amphotericin B deoxycholate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • clobetasone

              amphotericin B deoxycholate, clobetasone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • cortisone

              amphotericin B deoxycholate, cortisone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • cosyntropin

              amphotericin B deoxycholate, cosyntropin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • deflazacort

              amphotericin B deoxycholate, deflazacort. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • dexamethasone

              amphotericin B deoxycholate, dexamethasone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • flucytosine

              flucytosine increases effects of amphotericin B deoxycholate by pharmacodynamic synergism. Minor/Significance Unknown.

              amphotericin B deoxycholate increases levels of flucytosine by decreasing elimination. Minor/Significance Unknown.

            • fludrocortisone

              amphotericin B deoxycholate, fludrocortisone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • ganciclovir

              ganciclovir increases toxicity of amphotericin B deoxycholate by pharmacodynamic synergism. Minor/Significance Unknown.

            • hydrocortisone

              amphotericin B deoxycholate, hydrocortisone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • magnesium chloride

              amphotericin B deoxycholate decreases levels of magnesium chloride by increasing renal clearance. Minor/Significance Unknown.

            • magnesium citrate

              amphotericin B deoxycholate decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

            • magnesium hydroxide

              amphotericin B deoxycholate decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • magnesium oxide

              amphotericin B deoxycholate decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

            • magnesium sulfate

              amphotericin B deoxycholate decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

            • mestranol

              amphotericin B deoxycholate decreases effects of mestranol by increasing metabolism. Minor/Significance Unknown. May also cause menstrual irregularities.

            • methylprednisolone

              amphotericin B deoxycholate, methylprednisolone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • pentobarbital

              pentobarbital decreases levels of amphotericin B deoxycholate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • phenobarbital

              phenobarbital decreases levels of amphotericin B deoxycholate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • potassium acid phosphate

              amphotericin B deoxycholate decreases levels of potassium acid phosphate by increasing renal clearance. Minor/Significance Unknown.

            • potassium chloride

              amphotericin B deoxycholate decreases levels of potassium chloride by increasing renal clearance. Minor/Significance Unknown.

            • potassium citrate

              amphotericin B deoxycholate decreases levels of potassium citrate by increasing renal clearance. Minor/Significance Unknown.

            • prednisolone

              amphotericin B deoxycholate, prednisolone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • prednisone

              amphotericin B deoxycholate, prednisone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • primidone

              primidone decreases levels of amphotericin B deoxycholate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • secobarbital

              secobarbital decreases levels of amphotericin B deoxycholate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • valganciclovir

              valganciclovir increases toxicity of amphotericin B deoxycholate by pharmacodynamic synergism. Minor/Significance Unknown.

            • zidovudine

              zidovudine increases toxicity of amphotericin B deoxycholate by pharmacodynamic synergism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Anorexia

            Chills

            Diarrhea

            Fever

            Headache

            Hypokalemia

            Hypomagnesemia

            Hypotension

            Malaise

            Nausea

            Pain (generalized)

            Pain at injection site

            Renal function abnormalities

            Tachypnea

            Vomiting

            1-10%

            Arachnoiditis

            Delerium

            Flushing

            Hypertension

            Leukocytosis

            Lumbar nerve pain

            Paresthesia

            Urinary retention

            <1%

            Agranulocytosis

            Anuria

            Bone marrow suppression

            Cardiac arrest

            Coagulation defects

            Convulsions

            Dyspnea

            Hearing loss

            Leukopenia

            Maculopapular rash

            Renal failure

            Thrombocytopenia

            Vision changes

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            Warnings

            Drug should be used primarily for treatment of patients with progressive and potentially life-threatening fungal infections; should not be used to treat noninvasive forms of fungal disease such as oral thrush, vaginal candidiasis and esophageal candidiasis in patients with normal neutrophil counts

            Should not be given in doses greater than 1.5 mg/kg

            Exercise caution to prevent inadvertent overdosage, which may result in potentially fatal cardiac or cardiopulmonary arrest

            Verify the product name and dosage pre-administration, especially if dose exceeds 1.5 mg/kg

            Contraindications

            Hypersensitivity

            Cautions

            Therapy should be administered intravenously under close clinical observation by medically trained personnel; should be reserved for treatment of patients with progressive, potentially life-threatening fungal infections due to susceptible organisms

            Indicated for patients with progressive and potentially fatal fungal infections

            Do not use for noninvasive fungal infections (eg, oral thrush, vaginal candidiasis, esophageal candidiasis) in patients with normal neutrophil counts

            Acute reactions including fever, shaking chills, hypotension, anorexia, nausea, vomiting, headache, and tachypnea are common 1 to 3 hours after starting an intravenous infusion; reactions are usually more severe with first few doses of amphotericin B and usually diminish with subsequent doses

            Rapid intravenous infusion has been associated with hypotension, hypokalemia, arrhythmias, and shock and should, therefore, be avoided

            Since acute pulmonary reactions have been reported in patients given therapy during or shortly after leukocyte transfusions, it is advisable to temporarily separate these infusions as far as possible and to monitor pulmonary function

            Caution when coadministration with other drugs that cause hypokalemia (eg, corticosteroids, digoxin)

            Cases of new-onset dilated cardiomyopathy with subsequent heart failure have been reported; symptoms normalized within 6 months of discontinuation

            Leukoencephalopathy has been reported following use of amphotericin B; literature reports have suggested that total body irradiation may be a predisposition

            Amphotericin B should be used with care in patients with reduced renal function; frequent monitoring of renal function is recommended; in some patients hydration and sodium repletion prior to administration may reduce risk of developing nephrotoxicity; supplemental alkali medication may decrease renal tubular acidosis complications; however, do not withhold if risk of infection outweighs renal risk

            Whenever medication is interrupted for a period longer than seven days, therapy should be resumed by starting with the lowest dosage level, eg, 0.25 mg/kg of body weight, and increased gradually

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Excretion in milk is unknown; due to the potential for serious adverse reactions in breast-fed infants, a decision should be made whether to discontinue nursing or whether to discontinue the drug, taking into account the importance of the drug to the mother

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Vd: 4 L/kg

            Distribution: CholSO4 & lipid complex show lower kidney concs than conventional

            Protein Bound: 90%

            Half-Life, elimination: 15 days

            Half-Life, plasma: 24 hr

            Excretion: urine

            Mechanism of Action

            Acts by binding to sterols in fungal cell membrane, leading to alterations in cell permeability and cell death

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            Administration

            IV Incompatibilities

            Solution: D5/LR, D5/NS, LR, NS

            Additive: amikacin, CaCl2, Ca-gluconate, chlorpromazine, cimetidine, ciprofloxacin, diphenhydramine, dopamine, CaNa2EDTA, gentamicin, kanamycin, MgSO4, meropenem, metaraminol, methyldopate, penicillin G Na/K, polymyxin B SO4, KCl, prochlorperazine, ranitidine, streptomycin, verapamil

            Syringe: pantoprazole

            Y-site (partial list): allopurinol, amifostine, amsacarine, anidulafungin, aztreonam, bivalirudin, cefepine, cefpirone, cisatracurium(?), dexmedetomidine, docetaxel, doxorubicin liposomal, enalaprilat, etoposide PO4, fenoldopam mesylate, filgrastim, fluconazole, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, Hextend, lansoprazole, linezolid, melphalan, meropenem, ondansetron, paclitaxel, pemetrexed, piperacillin tazobactam, propofol, remifentanil(?), sargramostim(?), vinorelbine

            IV Compatibilities

            Solution: D5W, D10W

            Additive: fluconazole, heparin, hydrocortisone Na-PO4; hydrocortisone Na-succinate; NaHCO3

            Syringe: heparinY-site: aldesleukin, amiodarone, diltiazem, tacrolimus, teniposide, thiotepa, zidovudine

            IV Preparation

            Reconstitute 50 mg vial contents by adding 10 mL SWI without bacteriostatic agent to obtain a 5 mg/mL solution-add SWI rapidly & shake immediately until the colloidal dispersion is clear

            For IV infusion, dilute further (usually to 0.1 mg/mL) with 500 mL D5W (pH >4.2)

            Do not use if precipitate or foreign matter present

            Store dry form at 36-46°F (2-8°C)

            Protect from light

            IV Administration

            Use promptly after dilution

            Infuse over 2-6 hr

            May use an inline filter provided pore diameter >1 micron

            Do not mix or piggyback with amphotericin B

            Use IV site in distal vein

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            amphotericin B injection
            -
            50 mg vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            amphotericin B injection

            AMPHOTERICIN - INJECTION

            (AM-foe-TER-i-sin)

            COMMON BRAND NAME(S): Fungizone

            WARNING: Amphotericin should be used only to treat serious, possibly fatal fungal infections. This medication should not be used for less severe infections in limited areas of the body (e.g., fungal infection of the mouth/esophagus, vaginal yeast infections) in patients with normal white blood cell counts.

            USES: See also Warning section.This medication is used to treat a variety of serious, possibly fatal fungal infections. It works by stopping the growth of fungi.

            HOW TO USE: This medication is usually given by injection into a vein as directed by your doctor, usually given once a day or every other day. It should be injected slowly over 2 to 6 hours. Your doctor may give you a smaller dose first to test your response to the medication. Dosage is based on your medical condition, weight, response to the test dose, and response to therapy. If this medication is stopped for 7 days or longer, then it should be restarted at the lowest dose and slowly increased.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.It may be necessary to continue this medication for several weeks to several months in order to treat certain infections. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition persists or worsens.

            SIDE EFFECTS: Fever, shaking, chills, flushing, loss of appetite, dizziness, nausea, vomiting, headache, shortness of breath, or fast breathing may occur 1 to 3 hours after the infusion is started. In some cases, other medications (including acetaminophen, diphenhydramine, corticosteroids such as hydrocortisone) may be necessary to prevent or relieve these side effects. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: swelling/pain at injection site, muscle/joint pain, unusual tiredness, weakness, muscle cramping, signs of kidney problems (such as change in the amount of urine, painful urination), numbness/tingling of arms/legs, vision changes, hearing changes (e.g., ringing in the ears), dark urine, severe stomach/abdominal pain, yellowing eyes/skin, swelling ankles/feet, fast/slow/irregular heartbeat, cold sweats, blue lips, easy bruising/bleeding, other signs of infection (e.g., fever, persistent sore throat), mental/mood changes, seizures, black stools, vomit that looks like coffee grounds.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using amphotericin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: white blood cell (leukocyte) transfusions, heart disease (e.g., irregular heartbeat, congestive heart failure), liver disease, kidney disease.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: anti-cancer drugs (e.g., mechlorethamine, nitrogen mustard), azole antifungals (e.g., ketoconazole, itraconazole), cidofovir, digoxin, flucytosine, medications that affect the kidneys (including pentamidine, tacrolimus, aminoglycosides such as gentamicin), muscle relaxants (e.g., tubocurarine), zidovudine.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: dizziness, fainting, slow heartbeat, trouble breathing.

            NOTES: Laboratory and/or medical tests (e.g., kidney/liver function tests, potassium/magnesium levels, complete blood counts) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

            STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.