Parenteral Manual

Amphotericin-B

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Fungizone
Classification: 
Antifungal antibiotic
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • Treatment of aspergillosis, disseminated candidiasis and other severe systemic infections caused  by susceptible fungi.
Reconstitution and Stability: 
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
Compatibility: 

- 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

Administration: 

(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
Dosage: 

(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
Potential hazards of parenteral administration: 
  • Extravasation causes severe chemical irritation. If extravasation occurs, click HERE for treatment guidelines.
  • 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

Notes: 
  • 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

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