Amphotericin B liposomal: clinical use

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.

Dispersion for infusion

Route: Intravenous

Strengths: 50 mg