Amphotericin B liposomal: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Amphotericin B liposomal: clinical details
Prescribing considerations
- Confirm the complete product name and liposomal formulation at prescribing, dispensing, preparation and administration stages.
- Reserve for serious infections or other licensed indications under specialist supervision.
- Assess renal disease, concurrent nephrotoxins, electrolyte disturbance, previous infusion reactions and hepatic impairment.
- Account for the product's sucrose content in people with diabetes.
- Monitor during every infusion and stop immediately if severe allergy or anaphylaxis develops.
- Some phosphate assays may give falsely elevated results during treatment.
Contraindications and cautions
- Hypersensitivity to amphotericin B or any excipient, except where the physician judges that a life-threatening condition is treatable only with this medicine.
- Do not re-expose after a severe allergic or anaphylactic reaction to the product.
Monitoring
- Renal function and serum potassium before and during treatment.
- Magnesium and other clinically relevant electrolytes.
- Liver function and haematological parameters.
- Clinical observations during every infusion for allergy, cardiorespiratory effects and other infusion reactions.
- Pulmonary function when treatment occurs around leukocyte transfusion.
Clinical pharmacology
Amphotericin B is a macrocyclic polyene that binds fungal membrane sterols and disrupts membrane permeability. Liposomal encapsulation produces pharmacokinetics distinct from non-liposomal amphotericin B, with extensive tissue distribution and reduced interaction with distal renal tubular cells.
Formulation and product differences
- Amphotericin B liposomal and amphotericin B deoxycholate, including Fungizone, have materially different pharmacokinetics, toxicity and administration requirements and must not be substituted without explicit verification.
- Current UK liposomal amphotericin B products are considered bioequivalent to one another, but preparation and administration instructions remain product-specific.
- The selected product is a preservative-free powder for intravenous infusion containing hydrogenated soy phosphatidylcholine and sucrose. It requires sterile-water reconstitution and dextrose dilution and is incompatible with saline.
Amphotericin B liposomal preparations and strengths
Dispersion for infusion
Route: Intravenous
Strengths: 50 mg
Amphotericin B liposomal interactions
Specific interaction studies are limited, but clinically important interactions known for amphotericin B include:
Ciclosporin, tacrolimus, aminoglycosides, polymyxins or pentamidine
Other kidney-toxic medicines may increase renal injury, requiring closer kidney monitoring.
Loop or thiazide diuretics, corticosteroids or corticotropin
These can increase the likelihood or severity of low potassium.
Digitalis glycosides, such as digoxin
Low potassium caused by amphotericin B may increase digitalis toxicity and abnormal heart rhythms.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.