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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Amphotericin B Liposome
Brand Name
Amphotericin B Liposome
Generic Name
Amphotericin B Liposome
Active Ingredient
Amphotericin BCategory
Lipid-based Polyene Antifungal [EPC]
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 50 mg/12.5mL | INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | INTRAVENOUS | 67457-926 |
Detailed information about Amphotericin B Liposome
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Amphotericin B Liposome, you must consult a qualified healthcare professional.
Amphotericin B is a potent polyene antifungal medication used to treat life-threatening systemic fungal infections. It works by disrupting fungal cell membranes and is available in conventional and lipid-based formulations.
Dosage for Amphotericin B is highly individualized based on the patient's weight, the type of infection, and the specific formulation used. Because the formulations are not interchangeable, healthcare providers must be extremely careful to ensure the correct dose is administered for the specific product prescribed.
Amphotericin B is used in pediatric patients, including neonates, for systemic fungal infections. Dosing is weight-based and similar to adult protocols.
Studies have shown that children often tolerate Amphotericin B better than adults, experiencing fewer infusion-related reactions, though renal monitoring remains critical.
If a patient's serum creatinine increases significantly (e.g., exceeding 3.0 mg/dL), healthcare providers may temporarily discontinue the drug, reduce the dose, or switch to a lipid formulation. Nephrotoxicity is often dose-dependent and may be reversible if caught early.
While Amphotericin B is not primarily metabolized by the liver, patients with pre-existing liver disease should be monitored closely for signs of hepatotoxicity during treatment.
Geriatric patients are at a higher risk for kidney damage. Healthcare providers typically start at the lower end of the dosing range and monitor renal function more frequently.
Amphotericin B is administered as a slow intravenous infusion. It is never given as a rapid injection (bolus).
Because Amphotericin B is administered in a hospital or clinical setting, missed doses are rare. If a dose is delayed, the medical team will adjust the schedule. Patients should not attempt to 'double up' on doses if they are receiving home infusion therapy; instead, they should contact their infusion nurse or doctor immediately.
An overdose of Amphotericin B can be fatal, primarily due to cardiac or respiratory arrest. Symptoms of overdose include severe electrolyte imbalances, kidney failure, and dangerous heart arrhythmias. If an overdose is suspected, the infusion must be stopped immediately, and emergency supportive care (including monitoring of heart rhythm and electrolytes) must be initiated. There is no specific antidote for Amphotericin B; it is not effectively removed by hemodialysis.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or attempt to self-administer this medication without professional medical guidance.
Amphotericin B is known for a high incidence of side effects, particularly during the infusion process.
> Warning: Stop the infusion (if at home) and call your doctor immediately or seek emergency care if you experience any of the following:
Prolonged use of Amphotericin B can lead to permanent kidney damage (chronic kidney disease). It may also lead to persistent anemia that requires treatment with erythropoietin injections or blood transfusions. Some patients may develop 'renal tubular acidosis,' where the kidneys cannot properly remove acid from the blood, requiring long-term bicarbonate supplementation.
Amphotericin B carries a prominent FDA Black Box Warning regarding its use and potential for error. The warning states that the drug should be used primarily for the treatment of progressive and potentially fatal fungal infections and not for non-invasive fungal diseases (such as oral thrush or vaginal yeast infections) in patients with normal neutrophil counts. Furthermore, the warning emphasizes that the different formulations (conventional vs. lipid) have vastly different dosages; an overdose of conventional Amphotericin B (if mistaken for a lipid dose) can result in fatal cardiac arrest.
Report any unusual symptoms to your healthcare provider. Monitoring of blood work is essential throughout the entire course of therapy.
Amphotericin B is a high-alert medication. It must only be administered under the supervision of a physician experienced in the use of systemic antifungals. Patients must be hospitalized during the initial phase of treatment to monitor for acute reactions. Because the drug can remain in the body for several weeks, side effects or interactions can occur even after the treatment has ended.
Amphotericin B deoxycholate (conventional) should be used only for the treatment of patients with progressive and potentially fatal fungal infections. It should not be used to treat non-invasive fungal diseases.
Critical Note: Different formulations of Amphotericin B (e.g., AmBisome, Abelcet, and conventional deoxycholate) have different dosages and are not interchangeable. Healthcare providers must verify the product name and dosage before administration. A dose of 5 mg/kg is standard for lipid products but could be fatal if given as the conventional deoxycholate formulation.
Patients receiving Amphotericin B require intensive laboratory monitoring, typically daily or every other day:
Because Amphotericin B can cause dizziness, headaches, and blurred vision, patients should not drive or operate heavy machinery while receiving the infusion or if they feel unwell after a treatment session.
Alcohol should be avoided during Amphotericin B therapy. Alcohol can worsen dehydration and increase the strain on both the liver and kidneys, potentially exacerbating the drug's toxic effects.
Amphotericin B does not typically cause a 'withdrawal syndrome,' but stopping the drug prematurely can lead to a relapse of the fungal infection, which may then become resistant to treatment. The duration of therapy is determined by the clinical response and the total cumulative dose administered.
> Important: Discuss all your medical conditions, especially kidney or heart disease, with your healthcare provider before starting Amphotericin B.
Certain drugs should never be used alongside Amphotericin B due to the high risk of catastrophic toxicity:
Since Amphotericin B is administered intravenously, traditional food-drug absorption interactions are not a concern. However, nutritional status is vital. Patients may need a diet high in potassium and magnesium to counteract the losses caused by the medication. Dehydration must be avoided at all costs, as it increases the concentration of the drug in the kidneys.
Amphotericin B can interfere with certain laboratory results:
For each interaction, the primary management strategy is either dose adjustment, switching to a lipid formulation, or intensive monitoring of electrolytes and renal markers.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, including over-the-counter pain relievers like NSAIDs (Ibuprofen, Naproxen), which can further stress the kidneys.
Amphotericin B is contraindicated in patients who have a known hypersensitivity (severe allergy) to Amphotericin B or any of the components in the specific formulation being used.
Relative contraindications require a careful risk-benefit analysis by the medical team:
There is no significant evidence of cross-sensitivity between Amphotericin B and other classes of antifungals like azoles (Fluconazole) or echinocandins (Caspofungin). However, patients sensitive to one polyene (like Nystatin) should be monitored closely, although Nystatin is generally only used topically.
> Important: Your healthcare provider will evaluate your complete medical history, including any previous reactions to medications, before prescribing Amphotericin B.
Amphotericin B is generally classified as Pregnancy Category B (under the old FDA system). This means that animal reproduction studies have failed to demonstrate a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women.
It is not known whether Amphotericin B is excreted in human breast milk. Because many drugs are excreted in milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Amphotericin B is used in children of all ages, including infants. As noted in the usage section, children often tolerate the drug better than adults. However, the risk of long-term renal effects must be considered. Pediatric patients require the same intensive monitoring of electrolytes and kidney function as adults. Weight-based dosing must be calculated with extreme precision.
Elderly patients (over 65) are at a significantly higher risk for Amphotericin B-induced nephrotoxicity. This is because renal function naturally declines with age. Furthermore, elderly patients are more likely to be taking other medications (polypharmacy) that may interact with Amphotericin B. Healthcare providers usually monitor geriatric patients daily and utilize lipid formulations whenever possible to spare kidney function.
In patients with pre-existing renal impairment, the use of conventional Amphotericin B deoxycholate is generally avoided in favor of Liposomal Amphotericin B. Even with lipid formulations, the dose may need to be adjusted or the frequency of administration changed. The drug is not significantly cleared by hemodialysis or peritoneal dialysis; therefore, supplemental doses are not required after a dialysis session.
While the liver is not the primary site of clearance, Amphotericin B can occasionally cause hepatotoxicity. In patients with severe liver disease (Child-Pugh Class C), the drug should be used with caution, and liver enzymes should be monitored at least twice weekly.
> Important: Special populations require individualized medical assessment and often require more frequent laboratory monitoring to ensure safety.
Amphotericin B is a polyene antifungal that targets the fungal cell membrane. Its molecular structure consists of a large lactone ring with both a hydrophobic (water-fearing) polyene chain and a hydrophilic (water-loving) polyhydroxyl chain. This 'amphipathic' nature allows it to insert itself into the lipid bilayer of the fungal cell membrane.
The drug binds specifically to ergosterol. Once bound, multiple Amphotericin B molecules aggregate to form a cylindrical pore. These pores act as unregulated ion channels. Because the concentration of potassium is much higher inside the cell than outside, potassium ions rapidly exit the cell through these pores. This loss of ionic gradient destroys the cell's ability to maintain its membrane potential and produce energy, leading to cell death.
Amphotericin B exhibits concentration-dependent killing. This means that higher concentrations of the drug at the site of infection lead to faster and more thorough eradication of the fungus. It also exhibits a 'Post-Antifungal Effect' (PAFE), where fungal growth continues to be suppressed even after the drug levels drop below the minimum inhibitory concentration (MIC).
| Parameter | Value (Conventional) | Value (Liposomal) |
|---|---|---|
| Bioavailability | 0% (Oral) / 100% (IV) | 100% (IV) |
| Protein Binding | >90% | >90% |
| Half-life (Terminal) | ~15 Days | ~6-7 Days |
| Tmax | End of Infusion | End of Infusion |
| Metabolism | Non-CYP mediated | Minimal |
| Excretion | Renal (2-5%) / Biliary | Primarily Biliary |
Amphotericin B is the flagship member of the Polyene Antifungal class. Other drugs in this class include Nystatin (used topically/orally for local infections) and Natamycin (used for ophthalmic infections). It is distinct from the Azole class (e.g., Fluconazole) and the Echinocandin class (e.g., Micafungin) in both its mechanism and its spectrum of activity.
Common questions about Amphotericin B Liposome
Amphotericin B is a powerful antifungal medication used to treat severe, life-threatening fungal infections that affect the entire body. It is typically reserved for deep-seated infections like cryptococcal meningitis, invasive aspergillosis, and mucormycosis, which are often found in patients with weakened immune systems. Because it can be toxic to the kidneys, it is not used for minor infections like skin rashes or common yeast infections. Healthcare providers usually administer it in a hospital setting where they can monitor the patient's vital signs and organ function closely. It is often considered the 'last line of defense' against the most dangerous fungal pathogens.
The most common side effects are infusion-related reactions, which frequently include high fever, shaking chills (rigors), nausea, and headache. These symptoms often occur shortly after the infusion begins and are so common they are sometimes nicknamed 'shake and bake.' Additionally, most patients will experience some level of kidney strain, which is monitored through blood tests for creatinine. Low levels of potassium and magnesium in the blood are also very frequent, often requiring supplements. Anemia, or a low red blood cell count, is another common side effect that develops over the course of long-term treatment. Many of these effects can be managed with pre-medications or by using the newer lipid-based versions of the drug.
It is strongly advised to avoid alcohol while being treated with Amphotericin B. This medication is very hard on the kidneys and can sometimes affect the liver; alcohol also taxes these organs and can increase the risk of severe damage. Furthermore, alcohol can contribute to dehydration, which makes Amphotericin B even more toxic to the renal system. Since this drug is used for life-threatening infections, maintaining optimal hydration and organ function is critical for survival and recovery. Always consult your medical team before consuming any alcohol if you have recently received this medication, as it stays in your system for several weeks.
Amphotericin B is generally considered one of the safer options for treating life-threatening fungal infections during pregnancy when compared to other systemic antifungals. It is classified as Category B, meaning animal studies haven't shown harm to the fetus, though human data is limited. Doctors will typically use it if the mother's life is at risk from a severe fungal infection, as the benefits of treating the infection usually outweigh the potential risks to the baby. It does cross the placenta, but it has not been linked to birth defects in decades of clinical use. However, the mother's kidney function must be monitored even more carefully than usual during this time.
Amphotericin B begins working at the molecular level almost immediately after the infusion starts, as it begins binding to fungal cells in the bloodstream and tissues. However, visible clinical improvement in the patient may take several days or even weeks, depending on the severity and location of the infection. For example, treating fungal meningitis or deep bone infections requires a long course of therapy to ensure the fungus is fully eradicated. Doctors monitor the drug's effectiveness through follow-up cultures, imaging like CT scans, and the resolution of the patient's symptoms, such as fever. The total duration of treatment can range from a few weeks to several months.
You should never stop Amphotericin B treatment without the explicit direction of your infectious disease specialist. Fungal infections are notoriously difficult to clear, and stopping the medication too early can allow the infection to return, potentially in a form that is resistant to the drug. While there is no 'withdrawal' effect like you might see with some other medications, the danger lies in the 'rebound' of the underlying infection. If you are experiencing severe side effects, your doctor will not simply stop the drug but will instead adjust the dose, switch to a lipid-based formulation, or provide additional supportive care to help you complete the necessary course.
Since Amphotericin B is almost always given by healthcare professionals in a hospital or specialized infusion center, a missed dose is unlikely. However, if you are receiving home infusion and miss a scheduled dose, you should contact your healthcare provider or infusion nurse immediately for instructions. Do not attempt to double the dose to catch up, as this significantly increases the risk of fatal heart or kidney toxicity. Your medical team will likely reschedule the missed dose as soon as possible and may adjust the timing of your subsequent doses. Consistency is vital for keeping the drug levels high enough to kill the fungus.
Amphotericin B does not typically cause weight gain as a direct side effect. In fact, many patients lose weight during treatment because the drug often causes nausea, vomiting, and a loss of appetite. However, if a patient experiences sudden weight gain or swelling (edema) in the legs and ankles, it could be a sign of kidney impairment or heart strain. This is because the kidneys may not be effectively removing fluid from the body. Any rapid change in weight or new swelling should be reported to the medical team immediately, as it may require a change in the treatment plan or the use of diuretics.
Amphotericin B has many serious interactions with other drugs, particularly those that also affect the kidneys or electrolyte levels. For example, taking it with certain antibiotics (like gentamicin), chemotherapy (like cisplatin), or immunosuppressants (like cyclosporine) can greatly increase the risk of kidney failure. It can also make the heart medication Digoxin more dangerous by lowering potassium levels. Because of these risks, your doctor must review every single medication, vitamin, and herbal supplement you take. In many cases, other medications may need to be temporarily paused or their doses adjusted while you are receiving Amphotericin B.
Yes, conventional Amphotericin B deoxycholate is available as a generic medication and is relatively inexpensive. However, the newer lipid-based formulations, such as Liposomal Amphotericin B (AmBisome), were protected by patents for many years and are much more expensive. Generic versions of Liposomal Amphotericin B have recently become available in many markets, which has helped to reduce the cost of these safer formulations. Regardless of whether a brand-name or generic version is used, the medication must be handled and administered with the same high level of clinical care and monitoring.
Other drugs with the same active ingredient (Amphotericin B)