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Amphotericin B/Fungizone

  • for severe systemic fungal infections;
  • dose: 0.25mg/kg IV over 6hrs initially (infusion .1mg/ml);
  • gradually increase dose as tolerated up to 1-1.5mg/kg/24hrIV over 6hr;
  • note hypersensitivity, caution with nephrotoxic/antineoplastic agents;
  • monitor blood, liver, and renal function,
  • discontinue therapy if BUN >40mg/dl, Creatinine >3.0mg/dl, or if liver function test abnormalities are noted;
  • should be delivered via Central Line;
  • pretreatment with ASA, acetaminophren, and antihistamines (Benadryl) helps minimize adverse effects;
  • small amounts of heparin (1unit/ml) and hydrocortisone (2.5mg/mg Ampho) added to the infusion may help minimize phlebitis;
  • may consider 1mg test dose over 30min;
  • may also apply as a cream to supperficial Candida;
  • may also cause hypokalemia, fever; 
  • note diffusion from Blood into CSF is NIL even w/ Inflammation;
    • dosing regimens for patients with Renal Insufficiency: (Dose for 70kg Adult {gm/dosing interval in hours}):
      • CrCl:>80:0.02-0.05/24; CrCl:50-79:0.02-0.05/24; CrCl:30-49:0.02-0.05/24; CrCl:10-29:0.02-0.05/24;
  • 40% of drug excreted in urine over 7 days;
  • will interact with aminoglycosides (Incrnephrotoxicity), digitalis and neuromuscular blocking agents (due to Ampho induced Hypokalemia);
  • note: may cause HypoMagnesemia;
  • mixture interactions references