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amphotericin B deoxycholate (Rx)Brand and Other Names:amphotericin B (conventional), Fungizone

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 50mg/vial
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Systemic Fungal Infections

Test dose: 1 mg IV x1 infused over 20-30 min

Load: 0.25-0.5 mg/kg IV infused over 2-6 hr 

Maintenance: 0.25-1 mg/kg IV qDay OR up to 1.5 mg/kg IV qOD (may increase gradually by 0.25 mg-increments/day)

Renal Impairment

CrCl <10 mL/min: 0.5-0.7 mg/kg IV q24-48hr

Consider other antifungal agents that may be less nephrotoxic

Intermittent hemodialysis: 0.5-1 mg/kg IV q24hr after dialysis session

Continuous renal replacement therapy: 0.5-1 mg/kg IV q24hr

Other Indications & Uses

Aspergillosis, cryptococcosis, blastomycosis, systemic candidiasis, coccidioidomycosis, histoplasmosis, zygomycosis, sporotrichosis, leishmaniasis (not drug of choice)

Infections of Mucor, Rhizopus, Absidia, Conidiobolus, Basiobolus spp.

Off-label: amoebic meningoencephalitis (Naegleria fowleri); ocular aspergillosis; candidal cystitis; severe meningitis (intrathecal); coccidioidal arthritis (intra-articular or IM)

Dosage Forms & Strengths

powder for injection

  • 50mg/vial
more...

Systemic Fungal Infections

Test dose: 0.1 mg/kg IV, not to exceed 1 mg; administer over 20-60 min

Initial dose: 0.25 mg/kg/dose IV qDay/qOD

Maintenance: Increase by 0.25 mg/day increments as tolerated to 1-1.5 mg/kg/day

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Interactions

Interaction Checker

amphotericin B deoxycholate and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Anorexia

            Chills

            Diarrhea

            Fever

            Headache

            Hypokalemia

            Hypomagnesemia

            Hypotension

            Malaise

            Nausea

            Pain (generalized)

            Pain at injection site

            Renal function abnormalities

            Tachypnea

            Vomiting

            1-10%

            Arachnoiditis

            Delerium

            Flushing

            Hypertension

            Leukocytosis

            Lumbar nerve pain

            Paresthesia

            Urinary retention

            <1%

            Agranulocytosis

            Anuria

            Bone marrow suppression

            Cardiac arrest

            Coagulation defects

            Convulsions

            Dyspnea

            Hearing loss

            Leukopenia

            Maculopapular rash

            Renal failure

            Thrombocytopenia

            Vision changes

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Indicated for patients with progressive and potentially fatal fungal infections

            Do not use for noninvasive fungal infections (eg, oral thrush, vaginal candidiasis, esophageal candidiasis) in patients with normal neurophil counts

            Risk of nephrotoxicity, however, do not withhold if risk of infection outweighs renal risk

            Risk of acute infusion reactions, especially with first dose

            Caution when coadministration with other drugs that cause hypokalemia (eg, corticosteroids, digoxin)

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Excretion in milk is unknown; due to the potential for serious adverse reactions in breast-fed infants, a decision should be made whether to discontinue nursing or whether to discontinue the drug, taking into account the importance of the drug to the mother

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Vd: 4 L/kg

            Distribution: CholSO4 & lipid complex show lower kidney concs than conventional

            Protein Bound: 90%

            Half-Life, elimination: 15 days

            Half-Life, plasma: 24 hr

            Excretion: urine

            Mechanism of Action

            Acts by binding to sterols in fungal cell membrane, leading to alterations in cell permeability and cell death

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            Administration

            IV Incompatibilities

            Solution: D5/LR, D5/NS, LR, NS

            Additive: amikacin, CaCl2, Ca-gluconate, chlorpromazine, cimetidine, ciprofloxacin, diphenhydramine, dopamine, CaNa2EDTA, gentamicin, kanamycin, MgSO4, meropenem, metaraminol, methyldopate, penicillin G Na/K, polymyxin B SO4, KCl, prochlorperazine, ranitidine, streptomycin, verapamil

            Syringe: pantoprazole

            Y-site (partial list): allopurinol, amifostine, amsacarine, anidulafungin, aztreonam, bivalirudin, cefepine, cefpirone, cisatracurium(?), dexmedetomidine, docetaxel, doxorubicin liposomal, enalaprilat, etoposide PO4, fenoldopam mesylate, filgrastim, fluconazole, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, Hextend, lansoprazole, linezolid, melphalan, meropenem, ondansetron, paclitaxel, pemetrexed, piperacillin tazobactam, propofol, remifentanil(?), sargramostim(?), vinorelbine

            IV Compatibilities

            Solution: D5W, D10W

            Additive: fluconazole, heparin, hydrocortisone Na-PO4; hydrocortisone Na-succinate; NaHCO3

            Syringe: heparinY-site: aldesleukin, amiodarone, diltiazem, tacrolimus, teniposide, thiotepa, zidovudine

            IV Preparation

            Reconstitute 50 mg vial contents by adding 10 mL SWI without bacteriostatic agent to obtain a 5 mg/mL solution-add SWI rapidly & shake immediately until the colloidal dispersion is clear

            For IV infusion, dilute further (usually to 0.1 mg/mL) with 500 mL D5W (pH >4.2)

            Do not use if precipitate or foreign matter present

            Store dry form at 36-46°F (2-8°C)

            Protect from light

            IV Administration

            Use promptly after dilution

            Infuse over 2-6 hr

            May use an inline filter provided pore diameter >1 micron

            Do not mix or piggyback with amphotericin B

            Use IV site in distal vein

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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