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Name: Amphotericin B
Pregnancy Category B
Drug classes of Amphotericin
Therapeutic actions of Amphotericin
As with other polyene antifungals, amphotericin B associates with
ergosterol, a membrane chemical of fungi, forming a pore that leads
to K+ leakage and fungal cell death. Recently, however, researchers
found evidence that pore formation is not necessarily linked to cell
death (i.e. Angewandte Chemie Int. Ed. Engl. 2004). The actual
mechanism of action may be more complex and multi-faceted.
Indications of Amphotericin
Oral preparations of amphotericin B are rarely used.
- The main use is in systemic fungal infections (e.g. in
immunocompromised patients), and in visceral leishmaniasis.
Aspergillosis, cryptococcus infections (e.g. meningitis) and
candidiasis are treated with amphotericin B.
- It is also used empirically in febrile immunocompromised
patients who do not respond to broad-spectrum antibiotics.
Contraindications/cautions of Amphotericin
Hypersensitivity to amphotericin or any component of the
Avoid other nephrotoxic drugs or adminstration when BUN and serum
creatinine, postassium and magnesium levels are elevated. Monitor
renal function tests every 2-4 days or daily if at risk of
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Side-effects can be severe; nephrotoxicity (kidney
damage) is a major issue. Other side-effects include headache,
vomiting, convulsions and fever; it has to be withdrawn occasionally
from patients to determine whether their fever is due to
amphotericin B or an actual infection. A similar problem exists with
The side-effects are much milder when amphotericin B is
delivered in liposomes (AmBisome). This preparation is more
expensive, but makes the drug more tolerable, especially in patients
with known renal failure. The main side effect of liposomal
preparations is hypersensitivity reactions.