Amphotericin B chemical structure
Find information on thousands of medical conditions and prescription drugs.

Amphotec

Amphotericin B (Fungilin®, Fungizone®, Abelcet®, AmBisome®, Fungisome®, Amphocil®, Amphotec®) is a polyene antimycotic drug, used intravenously in systemic fungal infections. It was originally extracted from Streptomyces nodosus fungi. Currently the drug is available as plain Amphotericin B, as cholesteryl sulfate complex, as lipid complex, and as liposomal formulation. The latter formulations have been developed to improve tolerability for the patient but may show considerable pharmacokinetic characteristics compared to plain Amphotericin B. more...

Home
Diseases
Medicines
A
8-Hour Bayer
Abacavir
Abamectin
Abarelix
Abciximab
Abelcet
Abilify
Abreva
Acamprosate
Acarbose
Accolate
Accoleit
Accupril
Accurbron
Accure
Accuretic
Accutane
Acebutolol
Aceclidine
Acepromazine
Acesulfame
Acetaminophen
Acetazolamide
Acetohexamide
Acetohexamide
Acetylcholine chloride
Acetylcysteine
Acetyldigitoxin
Aciclovir
Acihexal
Acilac
Aciphex
Acitretin
Actifed
Actigall
Actiq
Actisite
Actonel
Actos
Acular
Acyclovir
Adalat
Adapalene
Adderall
Adefovir
Adrafinil
Adriamycin
Adriamycin
Advicor
Advil
Aerobid
Aerolate
Afrinol
Aggrenox
Agomelatine
Agrylin
Airomir
Alanine
Alavert
Albendazole
Alcaine
Alclometasone
Aldomet
Aldosterone
Alesse
Aleve
Alfenta
Alfentanil
Alfuzosin
Alimta
Alkeran
Alkeran
Allegra
Allopurinol
Alora
Alosetron
Alpidem
Alprazolam
Altace
Alteplase
Alvircept sudotox
Amantadine
Amaryl
Ambien
Ambisome
Amfetamine
Amicar
Amifostine
Amikacin
Amiloride
Amineptine
Aminocaproic acid
Aminoglutethimide
Aminophenazone
Aminophylline
Amiodarone
Amisulpride
Amitraz
Amitriptyline
Amlodipine
Amobarbital
Amohexal
Amoxapine
Amoxicillin
Amoxil
Amphetamine
Amphotec
Amphotericin B
Ampicillin
Anafranil
Anagrelide
Anakinra
Anaprox
Anastrozole
Ancef
Android
Anexsia
Aniracetam
Antabuse
Antitussive
Antivert
Apidra
Apresoline
Aquaphyllin
Aquaphyllin
Aranesp
Aranesp
Arava
Arestin
Arestin
Argatroban
Argatroban
Argatroban
Argatroban
Arginine
Arginine
Aricept
Aricept
Arimidex
Arimidex
Aripiprazole
Aripiprazole
Arixtra
Arixtra
Artane
Artane
Artemether
Artemether
Artemisinin
Artemisinin
Artesunate
Artesunate
Arthrotec
Arthrotec
Asacol
Ascorbic acid
Asmalix
Aspartame
Aspartic acid
Aspirin
Astemizole
Atacand
Atarax
Atehexal
Atenolol
Ativan
Atorvastatin
Atosiban
Atovaquone
Atridox
Atropine
Atrovent
Augmentin
Aureomycin
Avandia
Avapro
Avinza
Avizafone
Avobenzone
Avodart
Axid
Axotal
Azacitidine
Azahexal
Azathioprine
Azelaic acid
Azimilide
Azithromycin
Azlocillin
Azmacort
Aztreonam
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z

Uses

Oral preparations of amphotericin B are used to treat oral thrush; these are virtually nontoxic. The main i.v. use is in systemic fungal infections (e.g. in immunocompromised patients), and in visceral leishmaniasis. Aspergillosis, cryptococcus infections (e.g. meningitis) and candidiasis are treated with amphotericin B. It is also used empirically in febrile immunocompromised patients who do not respond to broad-spectrum antibiotics.

Method of action

As with other polyene antifungals, amphotericin B associates with ergosterol, a membrane chemical of fungi, forming a pore that leads to K+ leakage and fungal cell death. Recently, however, researchers found evidence that pore formation is not necessarily linked to cell death (i.e. Angewandte Chemie Int. Ed. Engl. 2004). The actual mechanism of action may be more complex and multi-faceted.

Side effects

Very often a most serious acute reaction after the infusion (1 to 3 hours later) is noted consisting of fever, shaking chills, hypotension, anorexia, nausea, vomiting, headache, dyspnea, and tachypnea. This reaction sometimes subsides with later applications of the drug and may in part be due to histamine liberation. An increase in prostaglandin-synthesis may also play a role. Often the most difficult decision has to be made, whether the fever is disease- or drug-related. In order to decrease the likelihood and severity of the symptoms, initial doses should be low and increased slowly. The liposomal preperation obviously has a lower incidence of the syndrome. Acetaminophen, pethidine, diphenhydramine and/or hydrocortisone have all be used to treat or prevent the syndrome, but the prophylactic use of these drugs should be limited.

Nephrotoxicity (kidney damage) is a major issue and can be severe and/or irreversible. It is much milder when amphotericin B is delivered in liposomes (AmBisome). Electrolyte imbalances (e.g. hypokalema and hypocalcemia) may also occur.

Increased liver enzymes and hepatotoxicity up to acute liver failure, several forms of anemia and other blood dyscrasias (leukopenia, thrombopenia), serious cardiac arrhythmias (including ventricular fibrillation), and cardiac failure have also been reported frequently. Skin reactions, including serious forms, are also possible.

Interactions

  • Flucytosine : Toxicity of Flucytosine increased and vice versa
  • Diuretics or Cisplatin : Increased renal toxicity and incrised risk of hypokalema
  • Corticosterioids : Increased risk of hypokalema
  • Cytostatic drugs : Increased risk of kidney damage, hypotension and bronchospasms.
  • Other nephrotoxic drugs : Increased risk of serious renal damage. Monitor patients closely.
  • Foscarnet, Ganciclovir, Tenofovir, Adefovir : Risk of hematological and renal side-effects of Amphotericin B increased.
  • Transfusion of Leukocytes : Risk of pulmonal (lung) damage. Space intervalls between the application of Amphotericin B and the transfusion and monitor pulmonal function.

Read more at Wikipedia.org


[List your site here Free!]


Amphotericin B reaction
From Nursing, 11/1/00 by Shuster, Joel

A 33-YEAR-OLD MAN was being treated for meningitis with amphotericin B through an intraventricular reservoir. Despite pretreatment medications, he experienced adverse reactions from the infusion and his infection progressed to the lumbosacral vertebral area. The intraventricular therapy was switched to IN. therapy, but he continued to have infusion-related adverse reactions.

Because of renal insufficiency, the patient was switched to IN. liposomal amphotericin B (Abelcet). This drug didn't cause infusion problems, but his serum creatinine remained elevated at 3.5 mg/dl (normal, 0.5 to 1.5 mg/dl). He took this second amphotericin product for 6 weeks, then was switched to IN. amphotericin B cholesteryl (Amphotec). After receiving the first dose, he felt severe back pain, which resolved in 5 minutes. The infusion rate was slowed, but within an hour, the patient developed swelling of the lips, hemiparesis on the left side, and difficulty breathing.

He was rushed to the ED and treated. The swelling quickly resolved and the hemiparesis abated within 24 hours.

What went wrong?

The physicians reporting this case believe the patient experienced an anaphylactic reaction to amphotericin B. The drug's manufacturer calls the patient's response an infusion reaction. Several formulations of amphotericin B are available, and patients may react differently to different forms. Rare reports of anaphylaxis have been associated with all products containing amphotericin B.

What precautions can you take?

Monitor your patient closely when switching from one form of amphotericin B to another, and during test doses.

Monitor the patient's creatinine level carefully and frequently during therapy; renal damage usually is reversible if therapy stops with the first sign of dysfunction.

Make sure the patient is stable on therapy before infusing amphotericin B in a home health care setting.

Sources: "Anaphylaxis upon Switching Lipid-containing Amphotericin B Formulations," Clinical Infectious Diseases, C. Kauffman and S. Wiseman, May 1998; "Anaphylaxis upon Switching Lipid-containing Amphotericin B Formulations [letter]," Clinical Infectious Diseases, J. Cronin and R. Barron, June 1999.

Dr. Shuster is associate professor of clinical pharmacology, Temple University, and clinical pharmacist, Medical College of Pennsylvania Hospital, both in Philadelphia, Pa. Send examples of adverse drug reactions to: Joel Shuster, PharmD, The Institute for Safe Medication Practices, 1800 Byberry Rd., Suite 810, Huntingdon Valley, PA 19006. E-mail: joel.shuster@tenethealth.com. Fax: 215-914-1492.

If we publish your item (anonymously), we'll pay you $25.

Copyright Springhouse Corporation Nov 2000
Provided by ProQuest Information and Learning Company. All rights Reserved

Return to Amphotec
Home Contact Resources Exchange Links ebay