Amphotericin B Liposomal Dosage

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Usual Adult Dose for Aspergillosis - Invasive

Systemic fungal infections: 3 to 5 mg/kg IV once a day

Doses as high as 10 mg/kg have been used in patients with documented Aspergillus infection.

The addition of flucytosine 25 to 37.5 mg/kg orally every 6 hours may be considered in HIV-infected patients with invasive candidiasis.

The total dose administered or duration of therapy will vary and depend on the nature and severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Adult Dose for Candidemia

Systemic fungal infections: 3 to 5 mg/kg IV once a day

Doses as high as 10 mg/kg have been used in patients with documented Aspergillus infection.

The addition of flucytosine 25 to 37.5 mg/kg orally every 6 hours may be considered in HIV-infected patients with invasive candidiasis.

The total dose administered or duration of therapy will vary and depend on the nature and severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Adult Dose for Cryptococcosis

Systemic fungal infections: 3 to 5 mg/kg IV once a day

Doses as high as 10 mg/kg have been used in patients with documented Aspergillus infection.

The addition of flucytosine 25 to 37.5 mg/kg orally every 6 hours may be considered in HIV-infected patients with invasive candidiasis.

The total dose administered or duration of therapy will vary and depend on the nature and severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Adult Dose for Febrile Neutropenia

Empirical therapy: 3 mg/kg IV once a day

The total dose administered or duration of therapy will vary and depend on the severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Adult Dose for Cryptococcal Meningitis - Immunosuppressed Host

HIV-infected patient: 6 mg/kg IV once a day

The addition of flucytosine 25 mg/kg orally every 6 hours may be considered.

The total dose administered or duration of therapy will vary and depend on the nature and severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Adult Dose for Leishmaniasis

Visceral leishmaniasis:
Immunocompetent patient: 3 mg/kg IV once a day on day 1 through 5, day 14, and day 21
Immunocompromised patient: 4 mg/kg IV once a day on day 1 through 5, day 10, day 17, day 24, day 31, and day 38

If the immunocompetent patient does not achieve parasitic clearance, a repeat course of therapy may be effective. If the immunocompromised patient does not achieve parasitic clearance or experiences a relapse, expert advice regarding future treatment is recommended.

Usual Pediatric Dose for Aspergillosis - Invasive

1 month or older:
Systemic fungal infections: 3 to 5 mg/kg IV once a day

Doses as high as 10 mg/kg have been used in patients with documented Aspergillus infection.

The addition of flucytosine 25 to 37.5 mg/kg orally every 6 hours may be considered for HIV-infected patients with invasive candidiasis.

The total dose administered or duration of therapy will vary and depend on the nature and severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Pediatric Dose for Candidemia

1 month or older:
Systemic fungal infections: 3 to 5 mg/kg IV once a day

Doses as high as 10 mg/kg have been used in patients with documented Aspergillus infection.

The addition of flucytosine 25 to 37.5 mg/kg orally every 6 hours may be considered for HIV-infected patients with invasive candidiasis.

The total dose administered or duration of therapy will vary and depend on the nature and severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Pediatric Dose for Cryptococcosis

1 month or older:
Systemic fungal infections: 3 to 5 mg/kg IV once a day

Doses as high as 10 mg/kg have been used in patients with documented Aspergillus infection.

The addition of flucytosine 25 to 37.5 mg/kg orally every 6 hours may be considered for HIV-infected patients with invasive candidiasis.

The total dose administered or duration of therapy will vary and depend on the nature and severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Pediatric Dose for Febrile Neutropenia

1 month or older:
Empirical therapy: 3 mg/kg IV once a day

The total dose administered or duration of therapy will vary and depend on the severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Pediatric Dose for Cryptococcal Meningitis - Immunosuppressed Host

1 month or older:
HIV-infected patient: 6 mg/kg IV once a day

The addition of flucytosine 25 mg/kg orally every 6 hours may be considered.

The total dose administered or duration of therapy will vary and depend on the nature and severity of the infection and the patient's tolerance to amphotericin B liposomal.

Usual Pediatric Dose for Leishmaniasis

1 month or older:
Visceral leishmaniasis:
Immunocompetent patient: 3 mg/kg IV once a day on day 1 through 5, day 14, and day 21
Immunocompromised patient: 4 mg/kg IV once a day on day 1 through 5, day 10, day 17, day 24, day 31, and day 38

If the immunocompetent patient does not achieve parasitic clearance, a repeat course of therapy may be effective. If the immunocompromised patient does not achieve parasitic clearance or experiences a relapse, expert advice regarding future treatment is recommended.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Adverse events have been demonstrated to be significantly less toxic than those occurring during administration of amphotericin B deoxycholate; however, serious adverse events may still occur. The drug should only be administered by medically trained personnel and patients should be closely monitored during initial dosing periods.

General reactions such as fever and chills/rigors occurring during amphotericin B liposomal infusions have been reported. These symptoms usually begin within a few minutes of initiation of an amphotericin B liposomal infusion and diminish with subsequent doses. Slowing the rate of infusion may control symptoms. Severe infusion-related side effects associated with conventional amphotericin B administration have been lessened by pretreatment/treatment with corticosteroids, acetaminophen, antihistamines, and meperidine.

Anaphylaxis has been reported with amphotericin B liposomal. If a severe anaphylactic reaction is observed, the infusion should be immediately discontinued and the patient should not receive further infusions.

Patient management should include laboratory monitoring of renal, hepatic, cardiac, and hematopoietic function, and serum electrolytes (particularly magnesium and potassium).

Safety and efficacy have not been established in pediatric patients less than one month of age.

Dialysis

Data not available

Other Comments

The manufacturer's directions should be strictly followed when reconstituting, filtering, and further diluting the drug. The IV infusion should be administered using a controlled infusion device over a period of approximately 120 minutes; however, the infusion time may be increased if the patient experiences discomfort. Also, the infusion time may be reduced to 60 minutes in patients in whom the treatment is well-tolerated.

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