Amphotericin

Amphotericin - is active against most fungi and yeasts. It also has useful activity against protozoa, including Leishmania spp., Naeglaria and Hartmanella. Amphocil is a colloidal formulation containing a stable complex of amphotericin and sodium cholesteryl sulphate. It is available in vials containing either 50 or 100mg amphotericin.This renders the drug less toxic to the kidney than the parent compound. Deterioration in renal function attributable to Amphocil is rare.

Uses:
Severe systemic fungal infections, when conventional amphotericin is
contraindicated because of toxicity, especially nephrotoxicity.

Administration:
• IV infusion: start at 1 mg/kg once daily, increasing to 3–4 mg/kg once daily, given over 60–90 min.

Amphocil must be initially reconstituted by adding WFI:
50-mg vial – add 10 ml WFI
100-mg vial – add 20 ml WFI

The liquid in each reconstituted vial will contain 5 mg/ml amphotericin. This is further diluted to a final concentration of 0.625 mg/ml by diluting 1 volume of the reconstituted Amphocil with 7 volumes glucose 5%. Flush an existing intravenous line with glucose 5% before infusion. Although anaphylactic reactions rare, before starting treatment, an initial test dose of 2 mg should be given over 10 min, infusion stopped and patient observed for 30 min. Continue infusion if no signs of anaphylactic reaction.

Monitor: serum potassium and magnesium. In renal dialysis patients, give Amphocil at the end of each dialysis.

How not to use colloidal amphotericin:
Must not be given by rapid IV infusion (arrhythmias)
Not compatible with sodium chloride
Do not mix with other drugs
There are several formulations of IV amphotericin and they are not
interchangeable. Errors of this sort have caused lethal consequences or
subtherapeutic doses.

Adverse effects:
Prevalence and severity lower than conventional amphotericin

Cautions:
Kidney disease
Concurrent use of nephrotoxic drugs
Avoid concurrent administration of corticosteroids (except to treat febrile and anaphylactic reactions)
Diabetes: Amphocil contains lactose monohydrate 950 mg/50-mg vial or 1900 mg/100-mg vial (may cause hyperglycaemia)