Amphotericin B

Amphotericin B Brand Names

Amphocin | Fungizone

What is Amphotericin B

Amphotericin B is a parenteral antifungal antibiotic produced as a fermentation by-product of Streptomyces nodosus, a soil actinomycete.

Amphotericin B is an older drug of the polyene class similar to nystatin. Amphotericin B is named for its amphoteric properties, which are acquired from a carboxyl group on the main ring and a primary amino group on mycosamine.

These groups confer improved aqueous solubility in acidic and basic environments.

Despite having many well-known side effects and toxicities and the introduction of several antifungal agents of the imidazole class, amphotericin B remains the drug of choice for many serious systemic fungal infections. The FDA approved amphotericin B in 1957.

Amphotericin B is available as an injection, oral suspension, ointment, lotion, and cream. In the 1990s, lipid formulations of amphotericin B became available (see separate monograph).

Intranasal amphotericin B is being studied for treatment of chronic rhinosinusitis (CRS). Phase III studies with amphotericin B for CRS are underway with SinuNase™ (amphotericin B suspension nasal lavage, 100 mcg/mL), an investigational product by Accentia Biopharmaceuticals.

Indications

  1. Absidia sp.
  2. Acanthamoeba castellanii
  3. Acanthamoeba polyphaga
  4. Acremonium sp.
  5. allergic bronchopulmonary aspergillosis
  6. aspergillosis
  7. aspergillosis prophylaxis
  8. Aspergillus fumigatus
  9. Aspergillus sp.
  10. Basidiobolus sp.
  11. Blastomyces dermatitidis
  12. blastomycosis
  13. bone and joint infections
  14. Candida albicans
  15. Candida sp.
  16. candidemia
  17. candidiasis
  18. candidiasis prophylaxis
  19. candiduria
  20. chorioretinitis
  21. Coccidioides immitis
  22. coccidioidomycosis
  23. Conidiobolus sp.
  24. cryptococcal meningitis
  25. cryptococcosis
  26. Cryptococcus neoformans
  27. Cryptococcus sp.
  28. cystitis
  29. endocarditis
  30. endophthalmitis
  31. Entomophthora sp.
  32. esophageal candidiasis
  33. febrile neutropenia
  34. fungal keratitis
  35. Histoplasma capsulatum
  36. histoplasmosis
  37. infectious arthritis
  38. intraabdominal abscess
  39. intraabdominal infections
  40. Leishmania braziliensis
  41. Leishmania donovani
  42. Leishmania infantum
  43. Leishmania mexicana
  44. Leishmania sp.
  45. Leishmania tropica
  46. leishmaniasis
  47. meningitis
  48. Mucor mucedo
  49. Mucor sp.
  50. mucormycosis
  51. myocarditis
  52. Naegleria fowleri
  53. Naegleria sp.
  54. oropharyngeal candidiasis (thrush)
  55. osteomyelitis
  56. Paracoccidioides brasiliensis
  57. pericarditis
  58. peritonitis
  59. phycomycosis
  60. pneumonia
  61. pyelonephritis
  62. Rhizopus sp.
  63. Rhodotorula sp.
  64. Sporothrix schenckii
  65. sporotrichosis
  66. Talaromyces marneffei
  67. talaromycosis
  68. urinary tract infection (UTI)

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. anaphylactoid reactions
  4. anemia
  5. anorexia
  6. anuria
  7. arachnoiditis
  8. arrhythmia exacerbation
  9. arthralgia
  10. azotemia
  11. bronchospasm
  12. cardiac arrest
  13. chills
  14. coagulopathy
  15. cough
  16. diabetes insipidus
  17. diarrhea
  18. diplopia
  19. dysgeusia
  20. dyspepsia
  21. dysphagia
  22. dyspnea
  23. elevated hepatic enzymes
  24. encephalopathy
  25. eosinophilia
  26. fever
  27. flushing
  28. headache
  29. hearing loss
  30. heart failure
  31. hepatic failure
  32. hepatitis
  33. hyperbilirubinemia
  34. hyperkalemia
  35. hypertension
  36. hypocalcemia
  37. hypokalemia
  38. hypomagnesemia
  39. hyposthenuria
  40. hypotension
  41. injection site reaction
  42. jaundice
  43. leukocytosis
  44. leukoencephalopathy
  45. leukopenia
  46. maculopapular rash
  47. malaise
  48. melena
  49. myalgia
  50. nausea
  51. nephrolithiasis
  52. oliguria
  53. paresthesias
  54. peripheral neuropathy
  55. phlebitis
  56. pneumonitis
  57. pruritus
  58. pulmonary edema
  59. rash
  60. renal failure (unspecified)
  61. renal tubular acidosis (RTA)
  62. seizures
  63. Stevens-Johnson syndrome
  64. tachypnea
  65. thrombocytopenia
  66. tinnitus
  67. toxic epidermal necrolysis
  68. ventricular fibrillation
  69. vertigo
  70. visual impairment
  71. vomiting
  72. weight loss
  73. wheezing

Monitoring Parameters

  • CBC
  • serum creatinine/BUN
  • serum magnesium
  • serum potassium
  • serum sodium

Contraindications

  • anemia
  • breast-feeding
  • children
  • electrolyte imbalance
  • hematological disease
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • infants
  • infusion-related reactions
  • leukopenia
  • neonates
  • potential for overdose or poisoning
  • pregnancy
  • renal disease
  • renal impairment
  • thrombocytopenia

Interactions

  • Acetazolamide
  • Acyclovir
  • Amikacin
  • Amiodarone
  • Amlodipine; Celecoxib
  • Aprotinin
  • Arsenic Trioxide
  • Atracurium
  • Bacillus Calmette-Guerin Vaccine, BCG
  • Bacitracin
  • Bacitracin; Hydrocortisone; Neomycin; Polymyxin B
  • Bacitracin; Neomycin; Polymyxin B
  • Bacitracin; Polymyxin B
  • Beractant
  • Bumetanide
  • Calfactant
  • Capreomycin
  • Cardiac glycosides
  • Celecoxib
  • Cidofovir
  • Cisapride
  • Cisatracurium
  • Cisplatin
  • Colfosceril; Cetyl Alcohol; Tyloxapol
  • 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
  • Gallium Ga 68 Dotatate
  • Ganciclovir
  • Gentamicin
  • Gold
  • Halofantrine
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydrocodone; Ibuprofen
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Immune Globulin IV, IVIG, IGIV
  • Indapamide
  • Indomethacin
  • Inotersen
  • Iohexol
  • Iopamidol
  • Iopromide
  • Ioversol
  • Isoproterenol
  • Isosulfan Blue
  • Itraconazole
  • Kanamycin
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lansoprazole; Naproxen
  • Levomethadyl
  • Loop diuretics
  • Mannitol
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Methazolamide
  • Mivacurium
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Neomycin
  • Neuromuscular blockers
  • Nilotinib
  • Non-Ionic Contrast Media
  • Nonsteroidal antiinflammatory drugs
  • Oxaprozin
  • Pancuronium
  • Paromomycin
  • Pentamidine
  • Pimozide
  • Piroxicam
  • Polymyxin B
  • Polymyxins
  • Poractant Alfa
  • Posaconazole
  • Rapacuronium
  • Rocuronium
  • Rofecoxib
  • Saccharomyces boulardii
  • Salicylates
  • Streptomycin
  • Succinylcholine
  • Sulindac
  • Surfactants
  • 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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