amphotericin B

Pronunciation

Generic Name: amphotericin B (am foe TER i sin)
Brand Name: Fungizone, Fungizone For Tissue Culture, Amphocin

What is amphotericin B?

Amphotericin B is an antifungal antibiotic that fights infections caused by fungus.

Amphotericin B is used to treat serious, life-threatening fungal infections. It is not for use in treating a minor fungal infection such as a yeast infection of the mouth, esophagus, or vagina.

Amphotericin B may also be used for purposes not listed in this medication guide.

What is the most important information I should know about amphotericin B?

This medicine is for serious, life-threatening fungal infections. It is not for use in treating a minor fungal infection (yeast infection) of the mouth, esophagus, or vagina.

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Do not use amphotericin B in larger amounts than recommended. An overdose can cause death.

What should I discuss with my health care provider before I receive amphotericin B?

You should not receive this medicine if you are allergic to any formulation of amphotericin B (Abelcet, AmBisome, Amphocin, Amphotec, or Fungizone).

To make sure amphotericin B is safe for you, tell your doctor if you have:

  • heart disease;

  • diabetes;

  • kidney disease;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • if you are receiving blood transfusions; or

  • if you are receiving radiation treatments.

FDA pregnancy category B. Amphotericin B is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether amphotericin B passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How is amphotericin B given?

Amphotericin B is injected into a vein through an IV. A healthcare provider will give you this injection.

The medicine must be given slowly through an IV infusion, and can take from 2 to 6 hours to complete.

Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when amphotericin B is injected.

Amphotericin B may need to be given for up to several weeks or months, depending on the infection being treated.

While receiving amphotericin B, you may need frequent blood tests.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Amphotericin B will not treat a viral infection such as the common cold or flu.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your amphotericin B injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of amphotericin B can be fatal.

What should I avoid while receiving amphotericin B?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Amphotericin B side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; wheezing, difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • pale skin, easy bruising;

  • blood in your stools;

  • a light-headed feeling, like you might pass out;

  • seizure (convulsions);

  • jaundice (yellowing of the skin or eyes);

  • build-up of fluid in your lungs--anxiety, sweating, gasping for breath, cough with foamy mucus, chest pain, fast or uneven heart rate;

  • signs of a kidney problem--little or no urinating; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath;

  • low potassium--confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling; or

  • signs of new infection--fever, chills, flu symptoms, mouth and throat ulcers, rapid and shallow breathing.

Common side effects may include:

  • nausea, vomiting, stomach pain, diarrhea;

  • upset stomach, loss of appetite;

  • muscle or joint pain;

  • headache, ringing in your ears;

  • pain, bruising, or swelling where the medicine was injected;

  • weight loss; or

  • flushing (warmth, redness, or tingly feeling).

See also: Side effects (in more detail)

Amphotericin B dosing information

Usual Adult Dose for Fungal Infection Prophylaxis:

Prevention of invasive Candidiasis in solid-organ transplants: 10 to 20 mg per day IV

Prevention of invasive Candidiasis during periods of risk - ICU and Other Care Settings (stay of 3 days or longer): 0.25 mg/kg per day IV

Usual Adult Dose for Aspergillosis -- Aspergilloma:

0.25 mg/kg per day IV
Daily dosage may be gradually increased to 0.5 to 1 mg/kg over a period of 2 to 4 days. Total doses range from 1 to 2 g.

Usual Adult Dose for Aspergillosis -- Invasive:

0.5 to 0.6 mg/kg per day IV
Daily doses as high as 1 to 1.5 mg/kg have been suggested by some clinicians. Total doses of 1.5 to 4 g have been given over an 11-month period.

Usual Adult Dose for Blastomycosis:

0.5 to 1 mg/kg per day IV
A total dose ranging from 1.5 to 2.5 g is needed for life-threatening disease. Patients with CNS infection should receive 0.7 to 1 mg/kg per day (total dose, at least 2 g).

Usual Adult Dose for Candida Urinary Tract Infection:

Candiduria: 0.3 to 1 mg/kg per day IV for 1 to 7 days
Bladder irrigation: 5 to 50 mg/L instilled into the bladder for 60 to 90 minutes and drained 4 times a day for 2 to 5 days

Usual Adult Dose for Candidemia:

Nonneutropenia: 0.6 to 1 mg/kg per day IV
Treatment duration should last 14 days after last positive blood culture and resolution of signs and symptoms.

Neutropenia: 0.7 to 1 mg/kg per day IV
Treatment duration should last 14 days past last positive blood culture and resolution of signs and symptoms.

Meningitis: 0.7 to 1 mg/kg per day IV plus flucytosine
Therapy should be administered for a minimum of 4 weeks after resolution of all signs and symptoms associated with the infection.

Endocarditis: 0.6 to 1 mg/kg per day IV for at least 6 weeks after valve replacement; flucytosine may be used concomitantly

Chronic disseminated: 0.6 to 0.7 mg/kg per day IV
Treatment duration may last 3 to 6 months and resolution or calcification of radiologic lesions.

The addition of oral flucytosine may be considered for HIV-infected patients with invasive candidiasis.

Usual Adult Dose for Coccidioidomycosis:

Respiratory infection: 0.5 to 1 mg/kg per day IV to a maximum of 1.5 mg/kg per day for 4 to 12 weeks

Usual Adult Dose for Coccidioidomycosis -- Meningitis:

0.01 to 1.5 mg intrathecal injection
It is administered at intervals ranging from daily to weekly, beginning at a low dose and increasing until patient intolerance appears. Concomitant azole therapy is started.

Usual Adult Dose for Cryptococcal Meningitis -- Immunocompetent Host:

0.7 to 1 mg/kg per day IV for 6 to 10 weeks
Therapy is given concomitantly with flucytosine.

Usual Adult Dose for Cryptococcal Meningitis -- Immunosuppressed Host:

0.7 to 1 mg/kg per day IV plus flucytosine for 2 weeks followed by fluconazole for a minimum of 10 weeks

Usual Adult Dose for Cryptococcosis:

Pulmonary: 0.5 to 1 mg/kg per day IV for 6 to 10 weeks
Total dose: 1 to 2 g

The addition of oral flucytosine may be considered.

Usual Adult Dose for Esophageal Candidiasis:

Severe and/or refractory esophageal candidiasis: 0.25 mg/kg per day IV
If tolerated, dosage may be gradually increased over 2 to 4 days to 0.3 to 0.7 mg/kg per day. Total doses range from 100 to 200 mg.

This drug should not be used to treat noninvasive fungal infections in patients with normal neutrophil counts.

Usual Adult Dose for Fungal Endocarditis:

0.25 mg/kg per day IV
Dosage may be gradually increased to 1 to 1.5 mg/kg per day over a period of 2 to 4 days. Total doses range from 1.5 to 3 g.

Usual Adult Dose for Histoplasmosis -- Immunocompenent Host:

Pulmonary: 0.7 mg/kg per day IV

Usual Adult Dose for Histoplasmosis -- Meningitis:

0.7 to 1 mg/kg per day IV to complete a 35 mg/kg total dose over 3 to 4 months

Usual Adult Dose for Oral Thrush:

Refractory or pharyngeal candidiasis: 0.25 mg/kg per day IV
Dosage may be gradually increased to 0.3 mg/kg per day over a period of 2 to 4 days. Total doses range from 100 to 200 mg.

This drug should not be used to treat noninvasive fungal infections in patients with normal neutrophil counts.

Usual Adult Dose for Paracoccidioidomycosis:

0.4 to 0.5 mg/kg per day IV to a maximum dose of 1.5 mg/kg per day in potentially fatal infections
Prolonged therapy is usually required.

Usual Adult Dose for Sporotrichosis:

0.4 to 0.5 mg/kg per day IV for 2 to 3 months
Therapy has ranged up to 9 months with a total dose up to 2.5 g.

Usual Adult Dose for Leishmaniasis:

Treatment of American cutaneous leishmaniasis (caused by L braziliense or L mexicana: 0.25 to 0.5 mg/kg per day IV
Dosage may be gradually increased to 0.5 to 1 mg/kg daily, at which time the drug is usually then given on alternate days. Duration of treatment may last from 3 to 12 weeks depending on severity of disease. Total dose ranges from 1 to 3 g.

Visceral Leishmaniasis: 0.5 to 1 mg/kg per day IV on alternate days for 14 to 20 doses

Maximum dose: 50 mg per day
Total dose: 1.5 to 2 g

Usual Pediatric Dose for Blastomycosis:

0.25 mg/kg per day IV
Total dose: greater than or equal to 30 mg/kg

Usual Pediatric Dose for Candidemia:

0.6 to 1 mg/kg per day IV for 14 to 21 days after resolution of signs and symptoms and negative repeat blood cultures

The addition of oral flucytosine may be considered for HIV-infected patients with invasive candidiasis.

Usual Pediatric Dose for Cryptococcal Meningitis -- Immunosuppressed Host:

HIV-infected patient: 0.25 to 1 mg/kg per day IV

The addition of oral flucytosine may be considered.

What other drugs will affect amphotericin B?

Other drugs may interact with amphotericin B, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about amphotericin B.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.01. Revision Date: 2014-03-06, 1:05:55 PM.

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