Amphotericin B liposomal (LAmB)

Amphotericin B liposomal Brand Name– AmBisome

What is Amphotericin B liposomal

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 liposomal injection (AmBisome, LAmB) was the last of three lipid amphotericin B preparations approved in the US.

LAmB is amphotericin B intercalated into a unilamellar bilayer liposomal membrane that has a diameter of less than 100 nm and consists of hydrogenated soy phosphatidylcholine (HSPC), cholesterol, distearoylphosphatidylglycerol, and alpha tocopherol. Incorporating amphotericin B into a liposomal membrane decreases the toxicity and alters the pharmacokinetic properties of the drug without diminishing its efficacy.

In studies involving patients with persistent fever and neutropenia, LAmB showed comparable success rates with fewer adverse events when compared to conventional amphotericin B.

Similarly, in studies of AIDS patients with Cryptococcus and Histoplasma capsulatum infections, treatment with LAmB resulted in equivalent success rates and fewer adverse events when compared to conventional amphotericin B.

LAmB is approved for empirical therapy in febrile, neutropenic patients with presumed fungal infections; for the treatment of Cryptococcal meningitis in HIV infected patients; for the treatment of patients with AspergillusCandida, or Cryptococcus species infections refractory to conventional amphotericin B or in patients where renal impairment or unacceptable toxicity precludes the use of conventional amphotericin B; and for the treatment of visceral leishmaniasis. LAmB was originally FDA approved in August 1997.

Indications

  1. aspergillosis
  2. aspergillosis prophylaxis
  3. Aspergillus flavus
  4. Aspergillus fumigatus
  5. Aspergillus sp.
  6. Blastomyces dermatitidis
  7. blastomycosis
  8. bone and joint infections
  9. Candida albicans
  10. Candida krusei
  11. Candida lusitaniae
  12. Candida parapsilosis
  13. Candida sp.
  14. Candida tropicalis
  15. candidemia
  16. candidiasis
  17. candidiasis prophylaxis
  18. chorioretinitis
  19. Coccidioides immitis
  20. coccidioidomycosis
  21. cryptococcal meningitis
  22. cryptococcosis
  23. Cryptococcus neoformans
  24. endocarditis
  25. endophthalmitis
  26. esophageal candidiasis
  27. febrile neutropenia
  28. Histoplasma capsulatum
  29. histoplasmosis
  30. infectious arthritis
  31. intraabdominal abscess
  32. intraabdominal infections
  33. Leishmania infantum
  34. leishmaniasis
  35. leishmaniasis prophylaxis
  36. meningitis
  37. myocarditis
  38. ophthalmic infection
  39. osteomyelitis
  40. Paracoccidioides brasiliensis
  41. pericarditis
  42. peritonitis
  43. pneumonia
  44. sinusitis
  45. sporotrichosis
  46. Talaromyces marneffei
  47. talaromycosis
  48. tracheobronchitis

Side Effects

  1. abdominal pain
  2. agitation
  3. agranulocytosis
  4. alopecia
  5. anaphylactoid reactions
  6. anemia
  7. angioedema
  8. anorexia
  9. anuria
  10. anxiety
  11. arrhythmia exacerbation
  12. arthralgia
  13. asthenia
  14. atrial fibrillation
  15. azotemia
  16. back pain
  17. bleeding
  18. bone pain
  19. bradycardia
  20. bronchospasm
  21. bullous rash
  22. cardiac arrest
  23. chest pain (unspecified)
  24. chills
  25. coagulopathy
  26. coma
  27. confusion
  28. conjunctivitis
  29. constipation
  30. cough
  31. cyanosis
  32. depression
  33. diabetes insipidus
  34. diarrhea
  35. dizziness
  36. drowsiness
  37. dysesthesia
  38. dyspepsia
  39. dysphagia
  40. dyspnea
  41. dystonic reaction
  42. dysuria
  43. ecchymosis
  44. edema
  45. elevated hepatic enzymes
  46. epistaxis
  47. eructation
  48. erythema
  49. fecal incontinence
  50. fever
  51. flatulence
  52. fluid retention
  53. flushing
  54. GI bleeding
  55. hallucinations
  56. headache
  57. hematemesis
  58. hematuria
  59. hemoptysis
  60. hemorrhagic cystitis
  61. hemorrhoids
  62. hepatomegaly
  63. hiccups
  64. hyperbilirubinemia
  65. hyperchloremia
  66. hyperglycemia
  67. hyperhidrosis
  68. hyperkalemia
  69. hypermagnesemia
  70. hypernatremia
  71. hyperphosphatemia
  72. hypertension
  73. hyperventilation
  74. hypervolemia
  75. hypocalcemia
  76. hypokalemia
  77. hypomagnesemia
  78. hyponatremia
  79. hypophosphatemia
  80. hyposthenuria
  81. hypotension
  82. hypoventilation
  83. hypoxia
  84. ileus
  85. infection
  86. influenza
  87. injection site reaction
  88. insomnia
  89. leukopenia
  90. maculopapular rash
  91. malaise
  92. metabolic acidosis
  93. myalgia
  94. nasal dryness
  95. nausea
  96. nephrolithiasis
  97. ocular hemorrhage
  98. orthostatic hypotension
  99. paresthesias
  100. peripheral edema
  101. peripheral vasodilation
  102. petechiae
  103. pharyngitis
  104. phlebitis
  105. pleural effusion
  106. pruritus
  107. pulmonary edema
  108. purpura
  109. rash
  110. renal failure (unspecified)
  111. renal tubular acidosis (RTA)
  112. rhabdomyolysis
  113. rhinitis
  114. seizures
  115. sinus tachycardia
  116. sinusitis
  117. skin discoloration
  118. skin ulcer
  119. stomatitis
  120. thrombocytopenia
  121. tremor
  122. urinary incontinence
  123. urticaria
  124. vaginal bleeding
  125. veno-occlusive disease (VOD)
  126. vesicular rash
  127. vomiting
  128. xerophthalmia
  129. xerosis
  130. 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
  • hyponatremia
  • hypotension
  • leukopenia
  • neonates
  • 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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