Amphotericin B, Liposomal

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

Liposomal Amphotericin B (Ambisome®)

Indication

  • Treatment of severe systemic infections caused by susceptible fungal pathogens, including Candida species

Dosage Guidelines

  • 3-5 mg/kg/dose IV q24 hours
  • Treatment should continue for at least 2 weeks after the first negative blood culture and signs and symptoms have resolved

Administration 

  • IV intermittent slow infusion over 2 hours
  • Incompatible with normal saline and TPN solutions.  Flush lines with Dextrose 5% ONLY prior to and following Ambisome administration
  • To make 20 mL of a 2 mg/mL solution:
    1. Reconstitution: add 12 mL sterile water for injection to 50 mg vial (concentration = 4 mg/mL)
    2. Shake vigorously for at least 30 seconds until dispersed into a translucent yellow suspension
    3. Draw up* 10 mL of the 4 mg/mL reconstituted solution
    4. Add to 10 mL D5W to make a total volume of 20 mL (final concentration = 2 mg/mL)

*Using 5-micron filter needle (supplied with vial)

Adverse Effects

  • Generally, less nephrotoxicity and infusion related adverse events than with conventional amphotericin B
  • Infusion related adverse effects (fever, chills, emesis) may occur 1 to 2 hours after starting infusion
  • Nephrotoxicity, hypokalemia, increased serum creatinine

Comments

  • Monitor serum potassium, magnesium, calcium, creatinine, urea, urine output, CBC and liver function tests
  • Renal toxicity is dose dependent; dose adjustments should be done only after considering the patient’s overall clinical picture

Supplied As

  • 50 mg vial
  • 2 mg/mL patient specific syringe, prepared by Pharmacy