Amphotericin B

Amphotericin B is antifungal antibiotic produced by Streptomyces nodosus. Amphotericin B is amphoteric polyene macrolide (containing many double bonds and a large lactone ring of 12 or more atoms). It has a broad spectrum of action and active against yeasts, organisms causing endemic mycoses and pathogenic molds.Amphotericin B is used topically for skin infections and intravenously for severe generalized fungal infections.

Brands
VAGMYCIN VAGMYCIN ANFOTERICINA FADA
Adult Dose
Dose: 40 to 80 mg
Single Dose: 60 (60)
Frequency: 6 hourly
Route: Buccal
Instructions:
Neonatal
Dose: 0.25 to 1 mg/kg
Single Dose: 0.62 (0.625)
Frequency: As recommended.
Route: Infusion
Instructions: Infuse over 6 hrs.
Paedriatic
Dose: 0.25 to 1 mg/kg
Single Dose: 0.62 (0.625)
Frequency: As recommended.
Route: IV Infusion
Instructions: Infuse over 6 hours
Characteristics
. It is of Semi Synthetic origin and belongs to Amphotericin. It belongs to Polyene Antibiotic, Tetracycline pharmacological group.The Molecular Weight of Amphotericin B is 924.10. Its pKa is 5.7, 10.
Contraindications
Amphotericin B is contraindicated in conditions like Hypersensitivity.
Effects
The severe or irreversible adverse effects of Amphotericin B, which give rise to further complications include Renal damage, Anaemia.Amphotericin B produces potentially life-threatening effects which include Anaphylactic reactions. which are responsible for the discontinuation of Amphotericin B therapy.The symptomatic adverse reactions produced by Amphotericin B are more or less tolerable and if they become severe, they can be treated symptomatically, these include Headache, Nausea, Vomiting, Anorexia, Fever, Abdominal pain, Chills, Azotemia.
Indications
Amphotericin B is primarily indicated in conditions like Candidiasis of mouth, Cutaneouus and mucocutaneous candidiasis, Denture stomatitis, Intestinal candidiasis, Severe shock due for example to cardiac arrest, Systemic mycoses, Vaginal candidiasis, Visceral leishmaniasis.
Interactions
Amphotericin B is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAdefovir DipivoxilAmikacin (Sulphate)Increased risk of nephrotoxicity when amphotericin given with Amikacin (Sulphate).Close monitoring required.BendrofluazideBetamethasoneIncreased risk of hypokalemia when corticosteroids (e.g Betamethasone) given with Amphoteracin B. ADVICE: Avoid concomitant use unless Amphotericin needed to control reactions.MajorCalcium GluconateCalcium GluconateCarbenicillin (Na)CarmustineChlorothiazideChlorthalidoneCisplatinDigoxinAmphotericin B may enhance the toxic effect of digoxin.ModerateClose monitoring required.DigoxinDiphenhydramineFlucytosineAmphotericin reduces renal excretion and increases cellular uptake of Flucytosine (toxicity possibly increased). FlucytosineFoscarnet (Na)Gallium NitrateGanciclovir (Na)HydrochlorothiazideIncreased risk of hypokalemia when amphotericin given with Hydrochlorothiazide.HydrocortisoneIncreased risk of hypokalemia when Amphotericin given with corticosteroids (e.g hydrocortisone). ADVICE: Avoid concomitant use unless corticosteroids needed to control the reactions.MajorKanamycin (Acid Sulphate)Increased risk of nephrotoxicity when amphotericin given with Amikacin (Sulphate).Close monitoring required.KetoconazoleEffects of amphotericin B possibly antagonised by Ketoconazole.Lactitol MonohydrateLignocaineMetaraminolMethylprednisoloneConcomitant use can lead to hypokalemiaMiconazole (Nitrate)Effects of amphotericin B possibly antagonised by Meconazole.NitrofurantoinOxaliplatinYou should inform your doctor before using this combination.Do not start or stop any medicine without doctor or pharmacist approval.Oxytetracycline (Dihydrate)PentamidineBoth drugs exert toxic effect on kidney result in increased nephrotoxicity.ModerateClosely monitor for renal function. Use an alternate antifungal in place of amphotericin B.PentamidinePossible increased risk of nephrotoxicity when Amphotericin given with Pentamidine.Close monitoring required.Polymyxin B (Sulphate)Procainamide (HCl)ProchlorperazineSodium CalciumedetateSodium ChlorideStreptomycinStrontium-89 ChlorideThe concomitant use of bone marrow depressants and strontium-89 chloride may have additive myelosuppressive effects. ModeratePatients should be monitored for excessive bone marrow suppression during treatment with strontium-89 chloride. Dose reductions of the other bone marrow depressants may be necessary.SulfapyridineConcurrent use of sulfapyridine with bone marrow depressants may increase the leukopenic or thrombocytopenic effects of these medications.If concurrent use is required, close observation for myelotoxic effects should be considered.TacrolimusIncreased risk of nephrotoxicity when amphotericin given with Tacrolimus.MajorClose monitorinrg required.Vancomycin (HCl)Both drugs produce nephrotoxic and neurotoxic effects results in increased adverse effects.ModerateClosely monitor for serum drug concentration, renal function andauditory and vestiular function.Zalcitabine These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Risks
Drug should not be given to Pregnant Mothers, and patients suffering from Kidney dysfunction.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Inj Store in refrigerator. Protect from Sunlight.
Warnings
Amphotericin B should be used with caution in patients with heart disease, liver disease, kidney disease or any allergies. This medication should be used only if clearly needed during pregnancy. Use of this medication is not recommended during lactation.
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