Therapeutic Action
Antifungal
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Drug reference
Antifungal
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Cryptococcal meningitis, when conventional amphotericin B is contra-indicated (severe pre- existing renal impairment or amphotericin B induced renal impairment) Mucocutaneous or visceral leishmaniasis Severe histoplasmosis
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May cause: intolerance reactions during administration: fever, chills, headache, nausea, vomiting, hypotension; local reaction: pain and thrombophlebitis at injection site; allergic reactions; gastrointestinal disturbances, disturbances in renal function (raised creatinine or urea levels, renal impairment), hypokalaemia, hypomagnesiemia, elevated liver enzymes; rarely, haematological disorders (thrombocytopenia, anaemia). Avoid combination with: drugs causing hypokalaemia (furosemide, corticosteroids), nephrotoxic drugs (amikacin, ciclosporine, tenofovir); digoxin, zidovudine. The infusion may be administered over 2 hours if necessary to prevent or minimize adverse effects. Monitor serum creatinine levels, and if possible, serum potassium levels (once to twice weekly) throughout treatment; adapt adjunctive therapy (potassium and magnesium supplementation) according to the results. If renal function deteriorates, reduce the dose by half for a few days. 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 12 ml of water for injection, to obtain a concentrated suspension containing 4 mg/ml With a syringe, withdraw the required dose of concentrated suspension. Attach the filter provided with the vial to the syringe; inject the contents of the syringe, through the filter, into the volume of 5% glucose (50 ml, 250 ml, 500 ml) needed to obtain a solution containing between 0.2 to 2 mg/ml, for IV perfusion.
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Cryptococcal meningitis, severe histoplasmosis Child over 1 month and adult: 3 mg/kg once daily over 30 to 60 minutes for 2 weeks Liposomal amphotericin B, 50 mg-vial in 12 ml G5% Volume of Volume Weight Daily dose Nb suspension required in mg of vials (4 mg/ml) to be for withdrawn administration 4 kg 12 3 ml 5 kg 15 4 ml 6 kg 18 4.5 ml 7 kg 21 5 ml 1 50 ml 8 kg 24 6 ml 9 kg 27 7 ml 10 kg 30 7.5 ml 15 kg 45 11 ml 20 kg 60 15 ml 25 kg 75 2 19 ml 250 ml 30 kg 90 23 ml 35 kg 105 26 ml 40 kg 120 30 ml 3 500 ml 45 kg 135 34 ml 50 kg 150 38 ml 55 kg 165 4 41 ml 500 ml 60 kg 180 45 ml 65 kg 195 50 ml 70 kg 210 5 53 ml 500 ml Mucocutaneous or visceral leishmaniasis Follow the recommended protocol, which varies from one region to another (exact dose, administration schedule, etc.). For information, the total dose in children over 1 month and adults is 15 to 30 mg/kg.
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Liposomal amphotericin B is better tolerated and less nephrotoxic than conventional amphotericin B. Do not add other drugs in the infusion bottle or bag; do not use the preparation if there is visible precipitation. Before each infusion, rinse the IV catheter with 5% glucose.
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Vial of powder: must be kept refrigerated (between 2 °C and 8 °C) or below 25 °C. Solutions (reconstituted and for infusion): be kept refrigerated 24 hours (between 2 °C and 8 °C).
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3 mg/kg once daily over 30 to 60 minutes for 2 weeks
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