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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 medication 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.

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.

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 antifungal medicine. 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 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 urination; 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).

Amphotericin B dosing information

Usual Adult Dose for Ocular Fungal Infection:

5 to 10 micrograms INTRAVITREALLY
-Use with systemic voriconazole.


Comments:
-Local drug concentration is lower if injected at the end of a pars plana vitrectomy, reducing retinal toxicity concerns.

Use(s): Aspergillus endophthalmitis

Usual Adult Dose for Aspergillosis -- Invasive:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to a final daily dose of 0.5 to 0.7 mg/kg IV once a day depending on cardio-renal status.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Cumulative dose: Up to 3.6 grams
Duration of therapy: Up to 11 months

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Blastomycosis:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Pulmonary blastomycosis (moderately severe to severe): 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted
-Follow with oral itraconazole.

Disseminated extrapulmonary blastomycosis(moderately severe to severe): 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted
-Follow with oral itraconazole.

Immunocompromised patients with blastomycosis: 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Candida Urinary Tract Infection:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Patients undergoing urologic procedures: 0.3 to 0.6 mg/kg IV once a day for several days before and after the procedure

Fluconazole-resistant candida glabrata: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days

Symptomatic ascending candida pyelonephritis from fluconazole-resistant candida glabrata: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days
-Use with or without flucytosine

Symptomatic ascending candida pyelonephritis from fluconazole-resistant candida kryseu: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days

Maximum IV dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED


Cystitis due to fluconazole-resistant species: 50 mg/mL in sterile water as a bladder irrigation once a day for 5 days

Candida urinary tract infection with fungus balls in patients with nephrostomy tubes: 25 to 50 mg in 200 to 500 mL sterile water IRRIGATED THROUGH the nephrostomy tubes


Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.
-Four week induction therapy is reserved for meningoencephalitis without neurological complications and cerebrospinal fluid yeast cultures that are negative after 2 weeks of treatment.
-In patients with neurological complications, consider using 6 weeks of induction therapy.
-If flucytosine is not given or treatment is interrupted, consider lengthening induction treatment at least 2 weeks.
-Patients at low risk of therapeutic failure (e.g. early diagnosis, no uncontrolled underlying disease, not immunocompromised, and excellent clinical response) consider decreasing induction treatment to 2 weeks.

Use(s): Candiduria

Usual Adult Dose for Candidemia:

Candida chorioretinitis without vitreous and with macular involvement: 5 to 10 mcg/0.1 mL sterile water by INTRAVITREAL injection
-For use with concomitant antifungal treatment (oral or IV)

Central nervous system candidiasis in patients in whom a ventricular device cannot be removed: 0.01 to 0.5 mg in 2 mL of 5% dextrose administered THROUGH THE DEVICE into the ventricle


Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Coccidioidomycosis:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Severe, non-meningeal infection: 0.7 to 1 mg/kg/day IV
Duration of therapy: Until clinical improvement
-Follow with a triazole.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Use(s): Coccidioidomycosis

Usual Adult Dose for Cryptococcal Meningitis -- Immunocompetent Host:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to thefinal daily dose depending on cardio-renal status.

Induction dose: 0.7 to 1 mg/kg IV once a day for at least 4 weeks
-Use in combination with flucytosine.
-Consolidation treatment is done with fluconazole.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.
-Four week induction therapy is reserved for meningoencephalitis without neurological complications and cerebrospinal fluid yeast cultures that are negative after 2 weeks of treatment.
-In patients with neurological complications, consider using 6 weeks of induction therapy.
-If flucytosine is not given or treatment is interrupted, consider lengthening induction treatment at least 2 weeks.
-Patients at low risk of therapeutic failure (e.g. early diagnosis, no uncontrolled underlying disease, not immunocompromised, and excellent clinical response) consider decreasing induction treatment to 2 weeks.

Use(s): Treatment of cryptococcal meningoencephalitis

Usual Adult Dose for Histoplasmosis -- Immunocompenent Host:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Moderately severe to severe pulmonary histoplasmosis: 0.7 to 1 mg/kg IV once a day
Duration of therapy: 1 to 2 weeks
-Follow with itraconazole.
-May use concomitant methylprednisolone for respiratory complications.
-Use this formulation if nephrotoxicity risk is low.

Moderately severe to severe progressive disseminated histoplasmosis: 3 mg/kg IV once a day
Duration of therapy: 1 to 2 weeks
-Follow with itraconazole.
-Use this formulation if nephrotoxicity risk is low.

Progressive disseminated histoplasmosis: 1 mg/kg IV once a day for 4 to 6 weeks
OR
1 mg/kg IV once a day for 2 to 4 weeks, followed by itraconazole
-Longer therapy may be needed for severe disease, immunosuppression, or primary immunodeficiency disorders.

CNS histoplasmosis: 1 mg/kg IV once a day
Duration of therapy: 4 to 6 weeks
-Follow with itraconazole.
-Use this formulation if nephrotoxicity risk is low.

Histoplasmosis in pregnancy: 3 to 5 mg/kg IV once a day
Duration of therapy: 4 to 6 weeks
-Use this formulation if nephrotoxicity risk is low.

Progressive disseminated histoplasmosis: 1 mg/kg IV once a day
Duration of therapy: 4 to 6 weeks; 2 to 4 weeks if followed by itraconazole
-Longer therapy may be needed for severe disease, immunosuppression, or primary immunodeficiency.


Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.
-Mild to moderate acute pulmonary histoplasmosis does not usually require treatment.

Usual Adult Dose for Oral Thrush:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Fluconazole-refractory oropharyngeal candidiasis: 0.3 mg/kg IV once a day

Esophageal candidiasis: 0.3 to 0.7 mg/kg IV once a day
-Use only if patients cannot tolerate oral therapy.
-Switch to oral fluconazole therapy when the patient can tolerate oral intake.

Fluconazole-refractory esophageal candidiasis: 0.3 to 0.7 mg/kg IV once a day
Duration of therapy: 21 days

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Sporotrichosis:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the final daily dose of 0.5 to 0.7 mg/kg IV once a day.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED
Cumulative dose: Up to 2.5 grams total
Duration of therapy: Up to 9 months

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Leishmaniasis:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Visceral Leishmaniasis: 0.75 to 1 mg/kg IV once a day or every other day for 20 to 30 doses

Mucosal Leishmaniasis: 0.1 to 1 mg/kg IV once a day for 20 to 45 doses

Cutaneous Leishmaniasis: 0.7 mg/kg IV once a day for 25 to 30 doses

Mucocutaneous Leishmaniasis: 0.7 to 1 mg/kg IV every other day for up to 25 to 45 doses

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Mucormycosis -- Invasive:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to a final daily dose of 0.5 to 0.7 mg/kg depending on cardio-renal status.
-A cumulative dose of at least 3 grams is recommended; although 3 to 4 grams infrequently cause lasting renal impairment, the dose is considered reasonable if clinical evidence of deep tissue infection is present, as this infection usually follows a rapidly fatal course.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.
-This disease generally occurs in association with diabetic ketoacidosis; it is imperative for diabetic control to be restored for treatment to be successful.

Use(s): Rhinocerebral mucormycosis (phycomycosis)

Usual Adult Dose for Systemic Fungal Infection:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes
-If initial dose is well tolerated, increase over a period of 2 days to:
Maintenance dose: 0.25 to 1 mg/kg slow IV daily
Duration of therapy: 10 to 14 days

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.
-This disease generally occurs in association with diabetic ketoacidosis; it is imperative for diabetic control to be restored for treatment to be successful.

Use(s): Systemic mycosis

Usual Pediatric Dose for Blastomycosis:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the recommended daily dose.

Children with severe blastomycosis: 0.7 to 1 mg/kg IV once a day
-Follow with fluconazole

Newborns with evidence of infection: 1 mg/kg IV once a day

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Usual Pediatric Dose for Candidemia:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the maintenance dose.

Maintenance dose: 1 mg/kg IV once a day
-An infusion time of 3 to 6 hours is recommended
Duration of therapy: 2 weeks after documented clearance of candida from the bloodstream, if neutropenia and candidemia symptoms have resolved


Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Usual Pediatric Dose for Cryptococcal Meningitis -- Immunosuppressed Host:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Induction dose: 0.7 to 1 mg/kg IV once a day - with concomitant fluconazole or flucytosine
Duration of therapy: 5 to 7 days

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED


Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Use(s): HIV-infected patients or organ transplant recipients with cryptococcal disease (meningeal and disseminated non-meningeal)

Usual Pediatric Dose for Systemic Fungal Infection:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes
-If initial dose is well tolerated, increase over a period of 2 days to:
Maintenance dose: 0.25 to 1 mg/kg slow IV daily
Duration of therapy: 10 to 14 days

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.
-This disease generally occurs in association with diabetic ketoacidosis; it is imperative for diabetic control to be restored for treatment to be successful.

Use(s): Systemic mycoses

Usual Pediatric Dose for Sporotrichosis:

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes
-If initial dose is well tolerated, increase over a period of 2 days to final dosing.

Disseminated sporotrichosis: 0.7 mg/kg IV once a day
-After a favorable response is seen, switch to itraconazole.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
-Administer primarily for progressive, potentially life-threatening fungal infections.
-Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
-Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
-The recommended concentration for infusion is 0.1 mg/mL.
-Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
-A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
-Optimal daily doses and ideal treatment durations are unknown.

Use(s): Sporotrichosis

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.

See also: Side effects (in more detail)

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: 2.03.

Last reviewed: March 10, 2016
Date modified: October 13, 2017

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