Therapeutic Action
Antifungal
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Drug reference
Antifungal
PDF page 348
Cryptococcal meningitis (induction phase), in combination with flucytosine or fluconazole Severe histoplasmosis or penicilliosis
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Administer with caution to patients with renal impairment. May cause: intolerance reactions during administration: fever, chills, headache, nausea, vomiting, hypotension; local reaction: pain and thrombophlebitis at injection site; allergic reactions; muscle or joint pain, cardiovascular disorders (arrhythmias, heart failure, hypertension, cardiac arrest), neurologic (seizures, blurred vision, dizziness), haematological or hepatic disorders; disturbances in renal function (reduced glomerular filtration, hypokalaemia, hypomagnesiemia). Avoid combination with: drugs causing hypokalaemia (furosemide, corticosteroids), nephrotoxic drugs (amikacin, ciclosporine, tenofovir); digoxin, zidovudine. To prevent renal toxicity, administer 500 ml to 1 litre of 0.9% NaCl or Ringer lactate prior to each amphotericin B infusion. In adults, as soon as the patient can swallow, give supplements of potassium (2 tab of 8 mmol 2 times daily) and magnesium (500 mg 2 times daily) until the end of amphotericin treatment. In the event of intolerance, stop infusion, give paracetamol or an antihistamine then, resume administration reducing infusion rate by half. Monitor serum creatinine levels, and if possible, serum potassium levels (1 to 2 times weekly) throughout treatment. If serum creatinine levels rise by over 50%, increase preventive hydration (1 litre every 8 hours) or stop treatment. Then, after improvement, resume amphotericin at the lowest effective dose or on alternate days. Use liposomal amphotericin B if serum creatinine levels increase again or if clearance is < 30 ml/minute or in patients with pre-existing severe renal failure. Pregnancy: check for renal dysfunction in the neonate if administered during the last month of pregnancy. Breast-feeding: avoid, except if vital
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Powder for injection, in 50 mg vial, to be dissolved in 10 ml of water for injection, to obtain a concentrated solution containing 5 mg/ml. The concentrated solution must be diluted in 500 ml of 5% glucose to obtain a solution containing 0.1 mg/ml, for slow IV infusion.
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Child and adult: 0.7 to 1 mg/kg once daily over 4 to 6 hours depending on tolerance
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Cryptococcal meningitis: one week if in combination with flucytosine; 2 weeks if in combination with fluconazole Histoplasmosis: 1 to 2 weeks Penicilliosis: 2 weeks
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Only use 5% glucose for administration (incompatible with other infusion fluids). Do not use the preparation if there is visible precipitation (the glucose solution is too acid). Do not add other drugs in the infusion bottle or bag. Protect infusion bottle from light during administration (wrap in dark paper).
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Vial of powder: must be kept refrigerated (between 2 °C and 8 °C); in the absence of a refrigerator, 7 days maximum, below 25 °C. Concentrated solution (5 mg/1 ml): may be kept refrigerated 24 hours (between 2 °C and 8 °C). Solution for infusion (0.1 mg/ml): must be used immediately.
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0.7 to 1 mg/kg once daily over 4 to 6 hours depending on tolerance
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