Names and pronunciation
(am-foe-ter′i-sin) Abelcet
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Drug reference
(am-foe-ter′i-sin) Abelcet
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Func. class.: Antifungal
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Chem. class.: Amphoteric polyene
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Do not confuse: Abelcet/amphotericin B
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ACTION: Increases cell membrane permeability in susceptible fungi by binding sterols; alters cell membrane, thereby causing leakage of cell compo- nents, cell death
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USES: Indicated for the treatment of invasive fungal infections in patients who cannot tolerate or have failed conven- tional amphotericin B therapy; broad- spectrum activity against many fungal, yeast and mold pathogen infections, including Aspergillus, Zygomycetes, Fusarium, Cryptococcus, and many hard-to-treat Candida species; Aspergil lus fumigatus, Aspergillus sp., Blasto myces dermatitidis, Candida albicans, Candida guilliermondii, Candida sp., Candida stellatoidea, Candida tropica lis, Coccidioides immitis, Cryptococ cus sp., Histoplasma sp., sporotrichosis
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Anemia, breastfeeding, cardiac disease, children, electrolyte imbalance, geriatric patients, hemato- logic/hepatic/renal disease, hypotension, pregnancy
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SIDE EFFECTS CNS: Headache, fever, chills, confusion, anxiety, insomnia CV: Hypotension, cardiac arrest, chest pain, hypertension, tachycardia, edema GI: Nausea, vomiting, anorexia, diar- rhea, cramps, bilirubinemia GU: Nephrotoxicity HEMA: Anemia, thrombocytopenia, agranulocytosis, leukopenia INTEG: Burning, irritation, pain, necro- sis at injection site with extravasation, rash, pruritus, dermatitis META: Hyponatremia, hypomagnesemia, hypokalemia MS: Arthralgia, myalgia, generalized pain, weakness, weight loss RESP: Dyspnea, wheezing, respiratory failure SYST: Toxic epidermal necrolysis, exfoli- ative dermatitis, anaphylaxis, sepsis, infection
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INTERACTIONS • Do not use with cidofovir Increase: nephrotoxicity—other nephro- toxic antibiotics (aminoglycosides, CISpla- tin, vancomycin, cycloSPORINE, polymyxin B), antineoplastics, pentamidine, salicy- lates, tacrolimus, tenofovir; use cautiously Increase: hypokalemia—corticosteroids, digoxin, skeletal muscle relaxants, thia- zides, loop diuretics; monitor electrolytes Decrease: amphotericin B lipid complex— azole antifungals; may still be used concur- rently in serious resistant infections Drug/Lab Test Increase: AST/ALT, alkaline phosphatase, BUN, creatinine, LDH, bilirubin Decrease: magnesium, potassium, HB, WBC, platelets
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DOSAGE AND ROUTES • Adult: IV 3-5 mg/kg/day Renal dose • Adult: IV CCr <10 mL/min give 5 mg/ kg q24-36hr
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Available forms: Suspension for injec- tion 5 mg/mL
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Administer: • Do not confuse the 4 different types; these are not interchangeable: con- ventional amphotericin B, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome • May premedicate with acetamino- phen, diphenhydrAMINE • Use only after C&S confirms organism IV route • Give product only after C&S confirms organism, product needed to treat condi- tion; make sure product is used for life- threatening infections • Handle with aseptic technique, am- photericin B lipid complex (ABLC) has no preservatives; visually inspect paren- teral products for particulate matter and discoloration before use Filtration and dilution: • Before dilution, store at 36°F-46°F (2°C-8°C), protected from moisture and light; do not freeze; the diluted, ready-for- use admixture is stable for up to 48 hours at 36°F-46°F (2°C-8°C) and an additional 6 hr at room temperature; do not freeze • Prepare by shaking the vial until no yellow sediment remains • Transfer the amount of drug from the required number of vials into one or more sterile syringes using an 18-gauge needle • Attach the provided 5-micron filter A needle to the syringe; inject the syringe contents through the filter needle into an IV bag containing the D5W injection; each filter needle may be used on the contents of no more than four 100-mg vials • The suspension must be diluted with D5W injection (1 mg/mL); for pediatric patients and patients with cardiovascular disease, the final concentration may be 2 mg/mL; DO NOT USE SALINE SOLUTIONS OR MIX WITH OTHER DRUGS OR ELECTRO- LYTES • The diluted ready-for-use admixture is stable for up to 48 hr at 36°F-46°F (2°C-8°C) and an additional 6 hr at room temperature; do not freeze IV INFUSION • Flush IV line with D5W injection be- fore use or use a separate IV line; DO NOT USE AN IN-LINE FILTER • Before infusion, shake the bag until thoroughly mixed; max rate 2.5 mg/kg/ hr; if the infusion time exceeds 2 hr, mix by shaking the infusion bag every 2 hr Y-site compatibilities: acyclovir, allo- purinol, aminocaproic acid, aminophyl- line, amiodarone, anidulafungin, argatroban, arsenic trioxide, atracurium, azithromycin, aztreonam, bumetanide, buprenorphine, busulfan, butorpha- nol, CARBOplatin, carmustine, ceFAZo- lin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cef- TRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, cisatracu- rium, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, dexamethasone, digoxin, diphenhydrA MINE, DOCEtaxel, doxacurium, DOXOru- bicin liposomal, enalaprilat, EPINEPHrine eptifibatide, ertapenem, etoposide, famotidine, fentaNYL, fludarabine, fluo- rouracil, fosphenytoin, furosemide, gan- ciclovir, granisetron, heparin, hydrocor- tisone, HYDROmorphone, ifosfamide, insulin, regular ketorolac, lepirudin, lidocaine, linezolid, LORazepam, mannitol, melphalan, meperidine, methotrexate, methylPREDNISolone, metoclopramide, mitoMYcin, mivacurium, nafcillin, nesirit- ide, nitroglycerin, nitroprusside, octreotide, oxaliplatin, PACLitaxel, pamidronate, pan- toprazole, PEMEtrexed, pentazocine, PEN- Tobarbital, PHENobarbital, phentolamine, piperacillin-tazobactam, procainamide, raNITIdine, succinylcholine, SUFentanil, tacrolimus, telavancin, teniposide, theophyl- line, thiopental, thiotepa, ticarcillin, ticarcillin- clavulanate, trimethobenzamide, verapamil, vinBLAStine, vinCRIStine, zidovudine, zole- dronic acid
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Assess: • VS every 15-30 min during first infu- sion; note changes in pulse, B/P • Blood studies: CBC, potassium, so- dium, calcium, magnesium every 2 wk; BUN, creatinine 2-3 ×/wk • Weight weekly; if weight increases by more than 2 lb/wk, edema is present; renal damage should be considered • For renal toxicity: increasing BUN, serum creatinine; if BUN is >40 mg/dL or if serum creatinine is >3 mg/dL, product may be discontinued, dosage reduced, I&O ratio; watch for decreasing urinary output, change in specific gravity; dis- continue product to prevent permanent damage to renal tubules • For hepatotoxicity: increasing AST, ALT, alkaline phosphatase, bilirubin • For allergic reaction: dermatitis, rash; product should be discontinued, antihistamines (mild reaction) or EPI- NEPHrine (severe reaction) should be administered • For hypokalemia: anorexia, drowsi- ness, weakness, decreased reflexes, dizzi- ness, increased urinary output, increased thirst, paresthesias • Infusion reactions: fever, chills, pain, swelling at site
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Evaluate: • Therapeutic response: resolution of infection, negative C&S for infecting or- ganism
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That long-term therapy may be needed to clear infection (2 wk-3 mo, depending on type of infection), frequent blood draws will be needed • To notify prescriber of bleeding, bruis- ing, or soft tissue swelling, neurologic, renal symptoms • Pregnancy/breastfeeding: to advise prescriber if pregnancy is planned or suspected; not to breastfeed HIGH ALERT
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PHARMACOKINETICS IV: half-life 7 days
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• Adult: IV 3-5 mg/kg/day Renal dose
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• Adult: IV CCr <10 mL/min give 5 mg/ kg q24-36hr
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