Amphotericin B lipid complex Brand Name– Abelcet
What is Amphotericin B lipid 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 lipid complex (Abelcet, ABLC) was the first lipid amphotericin B preparation available in the US.
ABLC is composed of ribbon-like structures with a size ranging from 1600 to 11000 nm and a 1:1 molar ration of amphotericin B-to-phospholipid [L-alpha-dimyristoylphosphatidylcholine (DMPC) and L-alpha-dimyristoylphosphatidylglycerol (DMPG)].
Incorporating amphotericin B into a lipid complex decreases the toxicity and alters the pharmacokinetic properties of the drug without diminishing its efficacy. Data from 3 open-label studies involving patients refractory to or intolerant of conventional amphotericin B demonstrated effectiveness of ABLC in the treatment of invasive fungal infections.
In addition, treatment with ABLC resulted in significantly lower incidence of nephrotoxicity when compared to conventional amphotericin B in the treatment of invasive candidiasis.
ABLC was approved by the FDA in November 1995; it is indicated for the treatment of invasive fungal infections in patients who are refractory to or intolerant of conventional amphotericin B therapy.
Indications
- aspergillosis
- Aspergillus fumigatus
- Aspergillus sp.
- Blastomyces dermatitidis
- blastomycosis
- bone and joint infections
- Candida albicans
- Candida guilliermondii
- Candida sp.
- Candida stellatoidea
- Candida tropicalis
- candidemia
- candidiasis
- Coccidioides immitis
- coccidioidomycosis
- cryptococcal meningitis
- cryptococcosis
- Cryptococcus sp.
- endocarditis
- endophthalmitis
- esophageal candidiasis
- febrile neutropenia
- Histoplasma sp.
- histoplasmosis
- infectious arthritis
- intraabdominal abscess
- intraabdominal infections
- leishmaniasis
- leishmaniasis prophylaxis
- meningitis
- myocarditis
- ophthalmic infection
- osteomyelitis
- pericarditis
- peritonitis
- pneumonia
- sinusitis
- sporotrichosis
- tracheobronchitis
Side Effects
- abdominal pain
- anaphylactoid reactions
- anemia
- anorexia
- anuria
- arrhythmia exacerbation
- arthralgia
- azotemia
- bone pain
- bronchospasm
- cardiac arrest
- cardiomyopathy
- chest pain (unspecified)
- chills
- cholangitis
- cholecystitis
- coagulopathy
- diarrhea
- diplopia
- dyspepsia
- dyspnea
- dysuria
- elevated hepatic enzymes
- encephalopathy
- eosinophilia
- erythema multiforme
- exfoliative dermatitis
- fever
- GI bleeding
- headache
- hearing loss
- heart failure
- hemoptysis
- hepatic failure
- hepatitis
- hepatomegaly
- hyperamylasemia
- hyperbilirubinemia
- hypercalcemia
- hyperglycemia
- hyperkalemia
- hypertension
- hyperuricemia
- hypocalcemia
- hypoglycemia
- hypokalemia
- hypomagnesemia
- hypophosphatemia
- hypotension
- impotence (erectile dysfunction)
- infection
- injection site reaction
- jaundice
- leukocytosis
- leukopenia
- maculopapular rash
- malaise
- melena
- metabolic acidosis
- musculoskeletal pain
- myasthenia
- myocardial infarction
- nausea
- oliguria
- peripheral neuropathy
- phlebitis
- pleural effusion
- pruritus
- pulmonary edema
- pulmonary embolism
- rash
- renal failure (unspecified)
- renal tubular acidosis (RTA)
- seizures
- stroke
- tachypnea
- thrombocytopenia
- tinnitus
- veno-occlusive disease (VOD)
- ventricular fibrillation
- vertigo
- visual impairment
- vomiting
- weight loss
- wheezing
Monitoring Parameters
- CBC
- LFTs
- platelet count
- serum creatinine/BUN
- serum magnesium
- serum potassium
- serum sodium
Contraindications
- anemia
- breast-feeding
- cardiac disease
- children
- electrolyte imbalance
- geriatric
- hematological disease
- hepatic disease
- hypercalcemia
- hyperkalemia
- hypertension
- hypocalcemia
- hypokalemia
- hypomagnesemia
- hypotension
- infants
- infusion-related reactions
- leukopenia
- neonates
- pregnancy
- renal disease
- renal failure
- renal impairment
- thrombocytopenia
Interactions
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- 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, 3TC; Zidovudine, ZDV
- 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
- Zidovudine, ZDV
