Amphotericin B

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Summary

Amphotericin B is an antifungal medication, usually reserved for use as a last resort for extremely severe or systemic fungal infections due to its many side effects. These side effects include nephrotoxicity, so closely monitor the patient’s BUN, creatinine, and urine output levels. Amphotericin B may also lower the patient’s potassium and magnesium levels, so supplementation of these electrolytes and frequent monitoring may be required. Amphotericin B also causes an infusion-related reaction that includes hypotension, fever, chills, and nausea. Other medications may be prescribed to mitigate these side effects, but the infusion should not be stopped when this reaction happens, as this is an expected reaction to an extremely strong medication.

Key Points

  • Amphotericin B
    • Mechanism
      • Antifungal
        • Binds to the fungal membrane to increase cell permeability and allow electrolytes to leak out of the cell, leading to fungal cell death.
    • Clinical Use
      • Systemic fungal infections
        • Candida albicans
        • Aspergillus fumigatus
        • Histoplasma capsulatum
        • Cryptococcus neoformans
    • Side Effects and Adverse Reactions
      • Nephrotoxicity
        • Closely monitor urinary output, BUN, and creatinine
      • Altered electrolyte balances
        • Hypokalemia
          • Will often require daily supplementation
        • Hypomagnesemia
          • Will often require daily supplementation
      • Expected Infusion-related Reaction
        • Symptoms include
          • Hypotension
          • Fever
          • Shaking / Chills
          • Tachycardia
          • Weakness
          • Muscle/Joint pain
        • Symptoms can be mitigated with antihistamines, antipyretics, corticosteroids, and/or antiemetics given before the amphotericin B infusion.
        • These symptoms are expected, and the medication should not be stopped because of these symptoms
        • Amphotericin B may be combined with a lipid complex, as it is thought to minimize these side effects, although it is used rarely due to the expensive cost
      • Thrombophlebitis