BMA Concise Guide to Medicine & Drugs

Amphotericin

Brand names Abelcet, AmBisome, Fungizone

Used in the following combined preparations None

QUICK REFERENCE

Drug group Antifungal drug

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Amphotericin is a highly effective and powerful antifungal drug. Although previously given by mouth to treat candida (thrush) infections of the mouth or intestines, it is now only given by injection to treat serious systemic fungal infections. All oral formulations have been discontinued in the UK. Injections are carefully supervised, usually in hospital, because of potentially serious adverse effects. A test dose for allergy may be given before a full injection. The newer formulations of amphotericin appear to be less toxic than the original injection.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Injection

Frequency and timing of doses Once daily.

Dosage range The dosage is determined individually.

Onset of effect Improvement may be noticed after 2–4 days.

Duration of action Up to several days.

Diet advice When given by injection, this drug may reduce the levels of potassium and magnesium in the blood. To correct this, mineral supplements may be recommended by your doctor.

Storage Not applicable. The drug is not normally kept in the home.

Missed dose If you miss your scheduled dose, contact your doctor as soon as possible.

Stopping the drug Discuss with your doctor. Stopping the drug prematurely may lead to worsening of the underlying condition.

Exceeding the dose Overdosage is unlikely since treatment is carefully monitored and supervised.

POSSIBLE ADVERSE EFFECTS

Adverse effects of amphotericin include pain at the injection site, nausea and vomiting, headache, fever, unusual bleeding, muscle and joint pain, indigestion, and abdominal pain. The drug is given only by injection under close medical supervision. Any adverse effects that develop are thus monitored closely and treated promptly.

INTERACTIONS (INJECTION ONLY)

Digitalis drugs Amphotericin may increase the toxicity of digoxin.

Diuretics Amphotericin increases the risk of low potassium levels with diuretics.

Aminoglycoside antibiotics Taken with amphotericin, these drugs increase the likelihood of kidney damage.

Corticosteroids may increase loss of potassium from the body caused by amphotericin.

Ciclosporin and tacrolimus increase the likelihood of kidney damage.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a long-term liver or kidney problem.

· You have previously had an allergic reaction to amphotericin.

· You are taking other medicines.

Pregnancy The drug is given only when the infection is very serious.

Breast-feeding It is not known whether the drug passes into the breast milk. Discuss with your doctor.

Infants and children Reduced dose may be necessary.

Over 60 No special problems.

Driving and hazardous work No known problems.

Alcohol No known problems.

PROLONGED USE

Given by injection, the drug may cause a reduction in blood levels of potassium and magnesium. It may also damage the kidneys and cause blood disorders.

Monitoring Regular blood tests to monitor liver and kidney function, blood cell counts, and potassium and magnesium levels are advised during treatment by injection.