- Treatment of aspergillosis, disseminated candidiasis and other severe systemic infections caused by susceptible fungi.
| VIAL SIZE | STERILE WATER for INJECTION REQUIRED | FINAL CONCENTRATION |
| 50 mg | 10 mL | 5 mg/mL |
- Store unopened vials in refrigerator. Protect from light
- Reconstituted vial stable 24 hours at room temperature or 7 days refrigerated
- Diluted in D5W to 0.1 mg/mL stable 24 hours at room temperature, 35 days refrigerated
- Diluted in D5W to 0.2-1 mg/mL stable 5 days at room temperature, 35 days refrigerated
- Solutions Compatible: dextrose solutions up to D20W
- Additives/Above Cassette Compatible: hydrocortisone sodium succinate (1 mg hydrocortisone per each mg amphotericin to maximum 25 mg of hydrocortisone)
- Y-site Compatible: no information
Incompatible: saline solutions, dextrose-saline combinations, potassium chloride, ondansetron, ranitidine, diphenhydramine, TPN, ringer's lactate
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct | NO (causes arrhythmias, bradycardia, hypotension) |
| IV Intermittent Infusion |
YES Syringe pump dilution: 0.1 mg/mL ONLY Large volume pump Usual dilution: 0.1 mg/mL Fluid restricted: 0.5 mg/mL via central line only
Infusion time: 2- 6 hours |
| IV Continuous Infusion | NO |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Adult/Pediatric:
- 0.25 mg/kg/day IV, increasing by increments of 0.25-0.5 mg/kg every 24-48 hours as tolerated to a maximum of 1.5 mg/kg/day
- WARNING - Exercise caution to prevent inadvertent amphotericin B (Fungizone) overdose. Verify the product name and dosage if dose exceeds 1.5 mg/kg/day
DOSING ADJUSTMENT IN RENAL IMPAIRMENT:
- If decreased renal function is due to amphotericin, decrease daily dose by 50% or give the dose every other day
- Extravasation causes severe chemical irritation. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
- Local phlebitis, thrombophlebitis
- Fever*, chills* (hypersensitivity)
- Hypokalemia*, hypomagnesemia
- Hypotension*, dysrhythmias*, arrhythmias*
- Headache, nausea, vomiting
- Muscle weakness, joint pain
- Anaphylaxis (rare)
- Nephrotoxicity (renal tubular acidosis, increased serum creatinine, oliguria)
* can be related to infusion rate
- Monitor vital signs throughout infusion
- Monitor electrolytes, serum creatinine and BUN closely, CBC, BP, intake/output
- Concomitant use of nephrotoxic antibiotics and antineoplastics increases the risk of nephrotoxicity
- Premedication with acetaminophen and diphenhydramine may help reduce severity of side effects
- Hydrocortisone (1 mg per mg of amphotericin) added to the infusion may help prevent immediate adverse reactions
- Meperidine as a pre-medication has been reported to reduce severity of febrile reactions
- Patients may require potassium supplementation
- Flush line with D5W prior to infusion
- Consider sodium loading to minimize the nephrotoxic risk
- Patient must be euvolemic with a normal serum sodium
- Contraindication - significant cardiac, renal, or respiratory compromise
- Procedure - infuse sodium chloride 0.9% 10 mL/kg (1.5 mmol Na/kg) IV over 60 minutes prior to Amphoterin B infusions
- Flush IV lines with dextrose solution prior to administraion of Amphotericin B due to incompatibility with saline-containing solutions
- Continue sodium loading for the duration of Amphotericin B therapy