Amphotericin B cholesteryl sulfate complex (ABCD)

Amphotericin B cholesteryl sulfate complex Brand Name

What is Amphotericin B cholesteryl sulfate complex

Amphotericin B is a polyene antifungal first isolated in 1955 from Streptomyces nodosus. In 1957, amphotericin B was approved for the treatment of progressive and potentially life threatening fungal infections.

Amphotericin B maintains a broad spectrum of activity with a low potential for resistance, yet despite its efficacy, the usefulness of amphotericin B has been limited by its severe toxicities.

To improve the tolerability of amphotericin B, three lipid-based formulations have been developed (amphotericin B lipid complex, amphotericin B cholesteryl sulfate complex, and amphotericin B liposomal injection). Amphotericin B cholesteryl sulfate complex (Amphotec, ABCD) was the second of three lipid amphotericin B preparations available in the US.

ABCD consists of a 1:1 molar ratio of amphotericin B and cholesteryl sulfate which, upon reconstitution, forms a colloidal dispersion of disc-shaped particles ranging in size from 120—140 nm.

Incorporating amphotericin B into a lipid complex decreases the toxicity and alters the pharmacokinetic properties of the drug without diminishing its efficacy.

Data from five open label studies involving patients refractory to or intolerant of conventional amphotericin B demonstrated effectiveness of ABCD in the treatment of Aspergillus infections.

In addition, treatment with ABCD resulted in equivalent efficacy and lower incidence of nephrotoxicity when compared to conventional amphotericin B for the treatment of invasive aspergillosis in immunocompromised patients. Of note, infusion-related toxicities occurred more frequently in those immunosuppressed patients receiving ABCD than in those receiving conventional amphotericin B.

ABCD is indicated for the treatment of invasive aspergillosis in patients who are refractory to or intolerant of conventional amphotericin B therapy. ABCD was FDA approved November 1996.

Indications

  1. aspergillosis
  2. Aspergillus fumigatus
  3. Aspergillus sp.
  4. blastomycosis
  5. Candida albicans
  6. Candida sp.
  7. candidemia
  8. candidiasis
  9. Coccidioides immitis
  10. coccidioidomycosis
  11. Cryptococcus neoformans
  12. endocarditis
  13. endophthalmitis
  14. esophageal candidiasis
  15. febrile neutropenia
  16. fungal keratitis
  17. histoplasmosis
  18. infectious arthritis
  19. Leishmania sp.
  20. leishmaniasis
  21. meningitis
  22. myocarditis
  23. osteomyelitis
  24. pericarditis
  25. peritonitis
  26. pneumonia
  27. sinusitis
  28. sporotrichosis
  29. tracheobronchitis

Side Effects

  1. abdominal pain
  2. acne vulgaris
  3. agitation
  4. alopecia
  5. amblyopia
  6. anaphylactoid reactions
  7. anemia
  8. anorexia
  9. anxiety
  10. apnea
  11. arrhythmia exacerbation
  12. arthralgia
  13. asthenia
  14. atrial fibrillation
  15. azotemia
  16. back pain
  17. bleeding
  18. bradycardia
  19. bullous rash
  20. cardiac arrest
  21. chest pain (unspecified)
  22. chills
  23. coagulopathy
  24. confusion
  25. constipation
  26. cough
  27. dehydration
  28. depression
  29. diarrhea
  30. dizziness
  31. drowsiness
  32. dysarthria
  33. dyspepsia
  34. dyspnea
  35. dysuria
  36. ecchymosis
  37. edema
  38. elevated hepatic enzymes
  39. epistaxis
  40. fecal incontinence
  41. fever
  42. GI bleeding
  43. gingivitis
  44. glossitis
  45. glycosuria
  46. hallucinations
  47. headache
  48. hearing loss
  49. heart failure
  50. hematemesis
  51. hematuria
  52. hemoptysis
  53. hepatic failure
  54. hyperbilirubinemia
  55. hyperglycemia
  56. hyperhidrosis
  57. hyperkalemia
  58. hyperlipidemia
  59. hypernatremia
  60. hypertension
  61. hypertonia
  62. hyperventilation
  63. hypervolemia
  64. hypocalcemia
  65. hypoglycemia
  66. hypokalemia
  67. hypomagnesemia
  68. hyponatremia
  69. hypophosphatemia
  70. hypotension
  71. hypothermia
  72. hypoxia
  73. infection
  74. injection site reaction
  75. insomnia
  76. jaundice
  77. leukocytosis
  78. leukopenia
  79. maculopapular rash
  80. melena
  81. metabolic acidosis
  82. myalgia
  83. nausea
  84. ocular hemorrhage
  85. oliguria
  86. oral ulceration
  87. orthostatic hypotension
  88. paresthesias
  89. peripheral edema
  90. peripheral neuropathy
  91. peripheral vasodilation
  92. petechiae
  93. pharyngitis
  94. phlebitis
  95. pleural effusion
  96. pruritus
  97. psychosis
  98. pulmonary edema
  99. rash
  100. renal failure (unspecified)
  101. renal tubular acidosis (RTA)
  102. renal tubular necrosis
  103. rhinitis
  104. seizures
  105. sinus tachycardia
  106. sinusitis
  107. skin discoloration
  108. skin ulcer
  109. stomatitis
  110. supraventricular tachycardia (SVT)
  111. syncope
  112. tachypnea
  113. thrombocytopenia
  114. tinnitus
  115. tremor
  116. urinary incontinence
  117. urinary retention
  118. urticaria
  119. veno-occlusive disease (VOD)
  120. vesicular rash
  121. vomiting
  122. weight gain
  123. weight loss
  124. xerostomia

Monitoring Parameters

  • CBC
  • LFTs
  • platelet count
  • serum creatinine/BUN
  • serum magnesium
  • serum potassium
  • serum sodium

Contraindications

  • anemia
  • breast-feeding
  • cardiac disease
  • electrolyte imbalance
  • geriatric
  • hematological disease
  • hepatic disease
  • hypertension
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypophosphatemia
  • hypotension
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • tachycardia
  • thrombocytopenia

Interactions

  • Acetazolamide
  • Acyclovir
  • Amikacin
  • Amiodarone
  • Amlodipine; Celecoxib
  • Aprotinin
  • Atracurium
  • Bacillus Calmette-Guerin Vaccine, BCG
  • Bacitracin
  • Bacitracin; Hydrocortisone; Neomycin; Polymyxin B
  • Bacitracin; Neomycin; Polymyxin B
  • Bacitracin; Polymyxin B
  • Bumetanide
  • Capreomycin
  • Cardiac glycosides
  • Celecoxib
  • Cidofovir
  • Cisapride
  • Cisatracurium
  • Cisplatin
  • Colistimethate, Colistin, Polymyxin E
  • Conivaptan
  • Corticosteroids
  • Cyclophosphamide
  • Cyclosporine
  • Daunorubicin Liposomal
  • Daunorubicin Liposomal; Cytarabine Liposomal
  • Dichlorphenamide
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Digitoxin
  • Digoxin
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dofetilide
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Doxacurium
  • Doxorubicin Liposomal
  • Dronabinol
  • Droperidol
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Entecavir
  • Esomeprazole; Naproxen
  • Ethacrynic Acid
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Fluconazole
  • Flucytosine
  • Flurbiprofen
  • Foscarnet
  • Furosemide
  • Gallium
  • Ganciclovir
  • Gentamicin
  • Gold
  • Halofantrine
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydrocodone; Ibuprofen
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Immune Globulin IV, IVIG, IGIV
  • Indapamide
  • Indomethacin
  • Inotersen
  • Isoproterenol
  • Itraconazole
  • Kanamycin
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lansoprazole; Naproxen
  • Levomethadyl
  • Loop diuretics
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Methazolamide
  • Mivacurium
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Neomycin
  • Neuromuscular blockers
  • Nilotinib
  • Nonsteroidal antiinflammatory drugs
  • Oxaprozin
  • Pancuronium
  • Paromomycin
  • Pentamidine
  • Pimozide
  • Piroxicam
  • Polymyxin B
  • Polymyxins
  • Rapacuronium
  • Rocuronium
  • Rofecoxib
  • Salicylates
  • Streptomycin
  • Succinylcholine
  • Sulindac
  • Tacrolimus
  • Telavancin
  • Telbivudine
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Thiazide diuretics
  • Tobramycin
  • Tolmetin
  • Torsemide
  • Tubocurarine
  • Valacyclovir
  • Valdecoxib
  • Valganciclovir
  • Vancomycin
  • Vecuronium
  • Voriconazole
  • Zalcitabine, ddC
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