Amphotericin B lipid complex (ABLC)

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

  1. aspergillosis
  2. Aspergillus fumigatus
  3. Aspergillus sp.
  4. Blastomyces dermatitidis
  5. blastomycosis
  6. bone and joint infections
  7. Candida albicans
  8. Candida guilliermondii
  9. Candida sp.
  10. Candida stellatoidea
  11. Candida tropicalis
  12. candidemia
  13. candidiasis
  14. Coccidioides immitis
  15. coccidioidomycosis
  16. cryptococcal meningitis
  17. cryptococcosis
  18. Cryptococcus sp.
  19. endocarditis
  20. endophthalmitis
  21. esophageal candidiasis
  22. febrile neutropenia
  23. Histoplasma sp.
  24. histoplasmosis
  25. infectious arthritis
  26. intraabdominal abscess
  27. intraabdominal infections
  28. leishmaniasis
  29. leishmaniasis prophylaxis
  30. meningitis
  31. myocarditis
  32. ophthalmic infection
  33. osteomyelitis
  34. pericarditis
  35. peritonitis
  36. pneumonia
  37. sinusitis
  38. sporotrichosis
  39. tracheobronchitis

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. anemia
  4. anorexia
  5. anuria
  6. arrhythmia exacerbation
  7. arthralgia
  8. azotemia
  9. bone pain
  10. bronchospasm
  11. cardiac arrest
  12. cardiomyopathy
  13. chest pain (unspecified)
  14. chills
  15. cholangitis
  16. cholecystitis
  17. coagulopathy
  18. diarrhea
  19. diplopia
  20. dyspepsia
  21. dyspnea
  22. dysuria
  23. elevated hepatic enzymes
  24. encephalopathy
  25. eosinophilia
  26. erythema multiforme
  27. exfoliative dermatitis
  28. fever
  29. GI bleeding
  30. headache
  31. hearing loss
  32. heart failure
  33. hemoptysis
  34. hepatic failure
  35. hepatitis
  36. hepatomegaly
  37. hyperamylasemia
  38. hyperbilirubinemia
  39. hypercalcemia
  40. hyperglycemia
  41. hyperkalemia
  42. hypertension
  43. hyperuricemia
  44. hypocalcemia
  45. hypoglycemia
  46. hypokalemia
  47. hypomagnesemia
  48. hypophosphatemia
  49. hypotension
  50. impotence (erectile dysfunction)
  51. infection
  52. injection site reaction
  53. jaundice
  54. leukocytosis
  55. leukopenia
  56. maculopapular rash
  57. malaise
  58. melena
  59. metabolic acidosis
  60. musculoskeletal pain
  61. myasthenia
  62. myocardial infarction
  63. nausea
  64. oliguria
  65. peripheral neuropathy
  66. phlebitis
  67. pleural effusion
  68. pruritus
  69. pulmonary edema
  70. pulmonary embolism
  71. rash
  72. renal failure (unspecified)
  73. renal tubular acidosis (RTA)
  74. seizures
  75. stroke
  76. tachypnea
  77. thrombocytopenia
  78. tinnitus
  79. veno-occlusive disease (VOD)
  80. ventricular fibrillation
  81. vertigo
  82. visual impairment
  83. vomiting
  84. weight loss
  85. 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
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