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 Aspergillus, Candida, 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
- aspergillosis
- aspergillosis prophylaxis
- Aspergillus flavus
- Aspergillus fumigatus
- Aspergillus sp.
- Blastomyces dermatitidis
- blastomycosis
- bone and joint infections
- Candida albicans
- Candida krusei
- Candida lusitaniae
- Candida parapsilosis
- Candida sp.
- Candida tropicalis
- candidemia
- candidiasis
- candidiasis prophylaxis
- chorioretinitis
- Coccidioides immitis
- coccidioidomycosis
- cryptococcal meningitis
- cryptococcosis
- Cryptococcus neoformans
- endocarditis
- endophthalmitis
- esophageal candidiasis
- febrile neutropenia
- Histoplasma capsulatum
- histoplasmosis
- infectious arthritis
- intraabdominal abscess
- intraabdominal infections
- Leishmania infantum
- leishmaniasis
- leishmaniasis prophylaxis
- meningitis
- myocarditis
- ophthalmic infection
- osteomyelitis
- Paracoccidioides brasiliensis
- pericarditis
- peritonitis
- pneumonia
- sinusitis
- sporotrichosis
- Talaromyces marneffei
- talaromycosis
- tracheobronchitis
Side Effects
- abdominal pain
- agitation
- agranulocytosis
- alopecia
- anaphylactoid reactions
- anemia
- angioedema
- anorexia
- anuria
- anxiety
- arrhythmia exacerbation
- arthralgia
- asthenia
- atrial fibrillation
- azotemia
- back pain
- bleeding
- bone pain
- bradycardia
- bronchospasm
- bullous rash
- cardiac arrest
- chest pain (unspecified)
- chills
- coagulopathy
- coma
- confusion
- conjunctivitis
- constipation
- cough
- cyanosis
- depression
- diabetes insipidus
- diarrhea
- dizziness
- drowsiness
- dysesthesia
- dyspepsia
- dysphagia
- dyspnea
- dystonic reaction
- dysuria
- ecchymosis
- edema
- elevated hepatic enzymes
- epistaxis
- eructation
- erythema
- fecal incontinence
- fever
- flatulence
- fluid retention
- flushing
- GI bleeding
- hallucinations
- headache
- hematemesis
- hematuria
- hemoptysis
- hemorrhagic cystitis
- hemorrhoids
- hepatomegaly
- hiccups
- hyperbilirubinemia
- hyperchloremia
- hyperglycemia
- hyperhidrosis
- hyperkalemia
- hypermagnesemia
- hypernatremia
- hyperphosphatemia
- hypertension
- hyperventilation
- hypervolemia
- hypocalcemia
- hypokalemia
- hypomagnesemia
- hyponatremia
- hypophosphatemia
- hyposthenuria
- hypotension
- hypoventilation
- hypoxia
- ileus
- infection
- influenza
- injection site reaction
- insomnia
- leukopenia
- maculopapular rash
- malaise
- metabolic acidosis
- myalgia
- nasal dryness
- nausea
- nephrolithiasis
- ocular hemorrhage
- orthostatic hypotension
- paresthesias
- peripheral edema
- peripheral vasodilation
- petechiae
- pharyngitis
- phlebitis
- pleural effusion
- pruritus
- pulmonary edema
- purpura
- rash
- renal failure (unspecified)
- renal tubular acidosis (RTA)
- rhabdomyolysis
- rhinitis
- seizures
- sinus tachycardia
- sinusitis
- skin discoloration
- skin ulcer
- stomatitis
- thrombocytopenia
- tremor
- urinary incontinence
- urticaria
- vaginal bleeding
- veno-occlusive disease (VOD)
- vesicular rash
- vomiting
- xerophthalmia
- xerosis
- 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