Amphotericin B: Antifungal Medication Uses, Dosage & Side Effects

Summary of Key Points

Amphotericin B is a powerful antifungal medication used to treat serious fungal infections, including those affecting the lungs, brain, and other organs. It works by disrupting the fungal cell membrane, ultimately leading to the destruction of the fungus. This medication is typically reserved for severe infections and is administered under close medical supervision. Always consult your healthcare provider before starting or adjusting your dose of Amphotericin B.

Names of Medication

US Brand Name: Abelcet, Ambisome, Amphotec

Generic Name: Amphotericin B

The generic name refers to the active ingredient in the medication. It is listed in parentheses next to the brand name.

Pharmacologic Category

Antifungal Agent

Polyene Antifungal

Amphotericin B Dosing Guidelines

Amphotericin B is used to treat a variety of serious fungal infections. The dosing depends on the type and severity of the infection being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. You can also schedule a telemedicine appointment with one of our providers for personalized guidance.

Common Dosing for Fungal Infections

1. Candidiasis: 0.3 to 0.6 mg/kg/day IV for 2-4 weeks or longer, depending on the severity of the infection.
2. Cryptococcosis: 0.7 to 1 mg/kg/day IV for 6-10 weeks, often in combination with other antifungal agents.
3. Aspergillosis: 0.5 to 1 mg/kg/day IV for 4-12 weeks, depending on the severity of the infection.
4. Histoplasmosis: 0.7 to 1 mg/kg/day IV for 6-12 weeks, depending on the severity of the infection.
5. Blastomycosis: 0.7 to 1 mg/kg/day IV for 6-12 weeks, depending on the severity of the infection.
6. Mucormycosis: 1 to 1.5 mg/kg/day IV for 4-6 weeks or longer, depending on the severity of the infection.
7. Leishmaniasis: 3 mg/kg/day IV for 5 days, followed by 3 mg/kg on day 10.
8. Sporotrichosis: 0.5 to 1 mg/kg/day IV for 4-6 weeks, depending on the severity of the infection.
9. Coccidioidomycosis: 0.5 to 1 mg/kg/day IV for 4-12 weeks, depending on the severity of the infection.
10. Zygomycosis: 1 to 1.5 mg/kg/day IV for 4-6 weeks or longer, depending on the severity of the infection.

Dosage Forms and Strengths

Amphotericin B is available in the following dosage forms:

1. Injection, IV: 50 mg/vial
2. Liposomal Injection (Ambisome): 50 mg/vial
3. Lipid Complex Injection (Abelcet): 100 mg/20 mL

Amphotericin B Administration Guidelines

Amphotericin B is administered intravenously (IV) in a hospital or clinical setting. The infusion is given slowly over several hours to minimize the risk of side effects. It is crucial to follow your healthcare provider’s instructions carefully. If you experience any unusual symptoms during or after the infusion, contact your healthcare provider immediately. You can also reach out to one of our telemedicine providers for assistance.

Amphotericin B Side Effects and Adverse Reactions

Like all medications, Amphotericin B can cause side effects. Some are more common, while others are rare but potentially serious. If you experience any of the following, contact your healthcare provider or schedule a telemedicine appointment with us right away.

Common Side Effects

1. Fever and chills: These may occur during or after the infusion.
2. Nausea and vomiting: Some patients may experience nausea or vomiting.
3. Headache: Mild to moderate headaches may occur.

Serious Side Effects

1. Kidney damage: Amphotericin B can affect kidney function, so regular monitoring is essential.
2. Low potassium levels: This can lead to muscle weakness or irregular heartbeats.
3. Severe allergic reactions: This includes difficulty breathing, swelling of the face, lips, or throat.

Contraindications for Amphotericin B

A contraindication is a specific condition or situation where a medication should not be used because it may be harmful. While Amphotericin B is effective for treating serious fungal infections, certain contraindications must be considered before starting treatment.

Key Contraindications

1. Hypersensitivity to Amphotericin B or its components: If you have a known allergy to Amphotericin B or any of its ingredients, taking this medication could trigger a severe allergic reaction, which may include symptoms like rash, difficulty breathing, or swelling.
2. Severe kidney dysfunction: Amphotericin B can be toxic to the kidneys, especially in patients with pre-existing kidney problems. If you have severe kidney disease, this medication may worsen your condition.
3. Electrolyte imbalances (low potassium or magnesium levels): Amphotericin B can cause or worsen low levels of potassium and magnesium in the blood, which can lead to dangerous heart rhythm problems. If you already have these imbalances, your healthcare provider may need to correct them before starting treatment.

If you have any of these conditions, it’s important to discuss them with your healthcare provider. Our telemedicine providers are available to help you determine if Amphotericin B is the right treatment for you.

Drug-to-Drug Interactions with Amphotericin B

Amphotericin B can interact with other medications, which may increase the risk of side effects or reduce the effectiveness of your treatment. Always inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements.

Medications That Interact with Amphotericin B

1. Cyclosporine (Sandimmune, Neoral): This immunosuppressant drug can increase the risk of kidney damage when taken with Amphotericin B.
2. Digoxin (Lanoxin): Amphotericin B can lower potassium levels, which may increase the risk of digoxin toxicity.
3. Corticosteroids (Prednisone, Dexamethasone): These medications can also lower potassium levels, compounding the risk of dangerous electrolyte imbalances when taken with Amphotericin B.
4. Flucytosine (Ancobon): This antifungal medication is sometimes used with Amphotericin B, but the combination can increase the risk of bone marrow suppression, leading to low blood cell counts.
5. Diuretics (Furosemide, Hydrochlorothiazide): These medications can increase the risk of kidney damage and electrolyte imbalances when taken with Amphotericin B.

Be sure to discuss any medications you are currently taking with your healthcare provider. Our telemedicine team can help you manage potential interactions and adjust your treatment plan as needed.

Amphotericin B in Pregnancy

Is it safe to take Amphotericin B during pregnancy?

Amphotericin B, a polyene antifungal medication, is classified as a Category B drug for pregnancy. This means that animal studies have not shown harm to the fetus, but there are no well-controlled studies in pregnant women. It is generally considered safe during pregnancy when the potential benefits outweigh the risks. However, Amphotericin B should only be used under the supervision of a healthcare provider. If you are pregnant or planning to become pregnant, it’s important to consult with one of our telemedicine providers to determine whether Amphotericin B is the right choice for your situation.

Amphotericin B while Breastfeeding

Is it safe to take Amphotericin B while breastfeeding?

There is limited information on whether Amphotericin B passes into breast milk. However, due to its poor absorption from the gastrointestinal tract, it is unlikely to pose a risk to a nursing infant. Still, the decision to use Amphotericin B while breastfeeding should be made in consultation with your healthcare provider. If you are breastfeeding, reach out to our telemedicine providers to discuss the most appropriate treatment options for both you and your baby.

Estimated Cost of Amphotericin B

The cost of Amphotericin B can vary depending on the formulation and dosage. Without insurance, the estimated cost of a 30-day supply using a GoodRx coupon ranges from approximately $50 to $200. Prices may differ based on the pharmacy and location. Be sure to explore discount options and consult your provider about the most cost-effective treatment plan for your needs.

Possible Alternatives to Amphotericin B

For certain fungal infections, alternative antifungal treatments or lifestyle adjustments may be considered. Always discuss these options with your healthcare provider before making any changes to your treatment plan.

1. Candidiasis: Alternatives include fluconazole (Diflucan) or itraconazole (Sporanox). Maintaining good hygiene and managing blood sugar levels can help prevent recurrent infections.
2. Cryptococcosis: Fluconazole (Diflucan) is often used as an alternative. In severe cases, flucytosine (Ancobon) may be combined with Amphotericin B.
3. Aspergillosis: Voriconazole (Vfend) is commonly used as an alternative. Reducing exposure to moldy environments may help prevent infection.
4. Histoplasmosis: Itraconazole (Sporanox) is often used as an alternative. Avoiding areas with bird or bat droppings can reduce the risk of infection.
5. Blastomycosis: Itraconazole (Sporanox) is a common alternative. Avoiding activities that disturb soil in endemic areas can reduce exposure.
6. Mucormycosis: Posaconazole (Noxafil) or isavuconazole (Cresemba) may be used as alternatives. Managing underlying conditions like diabetes can help lower the risk of infection.
7. Leishmaniasis: Alternatives include miltefosine (Impavido) or pentavalent antimonials. Preventing sandfly bites by using insect repellent and bed nets is crucial.
8. Sporotrichosis: Itraconazole (Sporanox) is often used as an alternative. Wearing protective clothing when handling soil or plants can help prevent infection.
9. Coccidioidomycosis: Fluconazole (Diflucan) or itraconazole (Sporanox) are common alternatives. Avoiding dust exposure in endemic areas can reduce the risk of infection.
10. Zygomycosis: Posaconazole (Noxafil) or isavuconazole (Cresemba) may be used as alternatives. Managing underlying health conditions and avoiding exposure to mold can help prevent infection.

If you are considering alternative treatments, our telemedicine providers can guide you through the available options and ensure you receive the best care for your condition.

Recent Updates on Amphotericin B Research

Recent research on Amphotericin B has focused on improving its safety profile, particularly in reducing its nephrotoxicity (kidney toxicity). Liposomal formulations, such as liposomal Amphotericin B (AmBisome), have been developed to minimize kidney damage while maintaining the drug’s effectiveness. Ongoing studies are also exploring the use of Amphotericin B in combination with other antifungal agents to enhance its efficacy and reduce side effects.

Additionally, researchers are investigating new delivery methods, such as inhaled Amphotericin B, to target fungal infections in the lungs more directly while minimizing systemic side effects. These advancements aim to make Amphotericin B a safer and more versatile option for treating severe fungal infections.

For the latest updates on Amphotericin B and how it may impact your treatment plan, consult one of our telemedicine providers today.

James Kingsley

Learn More