ADAP drugs: amphotericin B

amphotericin B (Fungizone)

Drug description

Amphotericin B is used to treat many fungal infections including histoplasmosis and Cryptococcus. Histoplasmosis spreads through the blood stream and may affect multiple organs and produce a wide variety of symptoms. The most common symptoms are fever, swollen glands, weight loss, respiratory problems, weakness, lethargy, and enlargement of the liver and spleen. Cryptococcus usually infects the membranes that cover the brain and spinal cord. If you are starting amphotericin B and are taking ddC, you should discontinue ddC until you are stable on amphotericin B. You should not take other drugs that can affect the kidneys, such as foscarnet, at the same time as amphotericin B. A less toxic form of amphotericin B, called lipid amphotericin B, is being studied. There is also a liquid form of the drug that can be taken orally for treating thrush that is resistant to other antifungal drugs.

Side effects
Amphotericin B can cause fevers, chills, headache, anorexia, nausea, vomiting, diarrhea, kidney damage, and suppression of bone marrow which can lead to anemia.

Dosage
Amphotericin B comes in topical , infusion and liquid form. The ointment is applied 2-4 times daily. Infusion is first given in a test dose of 1-5 mg, then treatment dose over 1 to 2 hours. You can get as much as 1 mg/kg/day or 1.5 mg/kg every other day. Amphotericin B infused rapidly is safe and better tolerated than the old long infusions. The old slow increase in dose is not always used. You may be given a test dose and then a full treatment dose. The recommended dose of the liquid formulation is 1 ml four times daily. Long term maintenance therapy for histoplasmosis is 50-80 mg IV. Itraconazole can also be used for maintenance treatment for histoplasmosis. Fluconazole, which has fewer side effects, is superior to amphotericin B for maintenance treatment for cryptococcus.

How long it may take to work
Long term maintenance of weekly or biweekly intravenous treatment is necessary. To treat Cryptococcal meningitis, the drug must be taken for 6-8 weeks or longer, depending on your response. To avoid relapse, you must have a catheter implanted in your chest for long term maintenance.

Managing side effects
Flu-like side effects can be reduced by taking ibuprofen (Advil), acetominophen (Tylenol), diphenhydramine (Benadryl), or hydrocortisone one half hour before infusion of amphotericin B. Some doctors will give you meperidine (Demerol) both before treatment and during treatment in the same IV bag with amphotericin B. Sometimes the drug is combined at lower doses with flucytosine if you can’t tolerate the side effects at full dose.

This information is specific to the use of this medication for HIV-related conditions. For additional information about this drug for other conditions, refer to: www.nursespdr.com/ and www.healthanswers.com/Library/library_fset.asp

The drug descriptions on these pages are intended for informational purposes only. The Network does not promote or endorse the use of any specific treatment for any health-related condition. The medications described here can only be dispensed by a licensed health care professional. The information may have changed since these pages were updated, though every effort is made to keep these pages current. Please contact The Network at (800) 734-7104 to make sure you have the most up-to-date information

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