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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 forumulation.

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 nephrotoxicity.

Adverse effects of Amphotericin

  • 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 Other side-effects include headache, vomiting, convulsions and fever; it has to be withdrawn occasionally from patients to determine whether their fever is due to amphotericin B or an actual infection.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 cytarabine.

  • 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.

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