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Medication Safety Issues
Safety issues:
Lipid-based amphotericin formulations (AmBisome®) may be confused with conventional formulations (Amphocin®, Fungizone®) or with other lipid-based amphotericin formulations (Abelcet®, Amphotec®)
Large overdoses have occurred when conventional formulations were dispensed inadvertently for lipid-based products. Single daily doses of conventional amphotericin formulation never exceed 1.5 mg/kg.
High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
Pronunciation
(am foe TER i sin bee lye po SO mal)
U.S. Brand Names
Index Terms
Generic Available
No
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Empirical therapy for presumed fungal infection in febrile, neutropenic patients; treatment of patients with Aspergillus species, Candida species, and/or Cryptococcus species infections refractory to amphotericin B desoxycholate (conventional amphotericin), or in patients where renal impairment or unacceptable toxicity precludes the use of amphotericin B desoxycholate; treatment of cryptococcal meningitis in HIV-infected patients; treatment of visceral leishmaniasis
Use: Unlabeled/Investigational
Treatment of systemic Histoplasmosis infection
Pregnancy Risk Factor
B
Pregnancy Considerations
Animal studies did not demonstrate teratogenicity. There are no adequate and well-controlled studies in pregnant women. Conventional amphotericin B has been used successfully to treat systemic fungal infection in a limited number (case reports) of pregnant women.
Lactation
Excretion in breast milk unknown/not recommended
Breast-Feeding Considerations
Due to the potential for serious adverse reactions in the nursing infant, breast-feeding is not recommended.
Contraindications
Hypersensitivity to amphotericin B deoxycholate or any component of the formulation
Warnings/Precautions
Concerns related to adverse effects:
• Anaphylaxis: Has been reported with amphotericin B-containing drugs; facilities for cardiopulmonary resuscitation should be available during administration due to the possibility of anaphylactic reaction. If severe respiratory distress occurs, the infusion should be immediately discontinued; the patient should not receive further infusions. Administer under close clinical observation during initial dosing.
• Infusion reactions: Acute reactions (including fever and chills) may occur 1-3 hours after starting infusions; reactions are more common with the first few doses and generally diminish with subsequent doses. Immediately discontinue infusion if severe respiratory distress occurs; the patient should not receive further infusions.
Concurrent drug therapy issues:
• Antineoplastics: Concurrent use with antineoplastic agents may enhance the potential for renal toxicity, bronchospasm or hypotension.
• Nephrotoxic drugs: Concurrent use of amphotericin B with other nephrotoxic drugs may enhance the potential for drug-induced renal toxicity.
Special populations:
• Pediatrics: Safety and efficacy have not been established in patients <1 month of age.
Other warnings/precautions:
• Leukocyte transfusions: Acute pulmonary toxicity has been reported in patients receiving simultaneous leukocyte transfusions and amphotericin B.
Adverse Reactions
Percentage of adverse reactions is dependent upon population studied and may vary with respect to premedications and underlying illness. Incidence of decreased renal function and infusion-related events are lower than rates observed with amphotericin B deoxycholate.
>10%:
Cardiovascular: Peripheral edema (15%), edema (12% to 14%), tachycardia (9% to 19%), hypotension (7% to 14%), hypertension (8% to 20%), chest pain (8% to 12%), hypervolemia (8% to 12%)
Central nervous system: Chills (29% to 48%), insomnia (17% to 22%), headache (9% to 20%), anxiety (7% to 14%), pain (14%), confusion (9% to 13%)
Dermatologic: Rash (5% to 25%), pruritus (11%)
Endocrine & metabolic: Hypokalemia (31% to 51%), hypomagnesemia (15% to 50%), hyperglycemia (8% to 23%), hypocalcemia (5% to 18%), hyponatremia (9% to 12%)
Gastrointestinal: Nausea (16% to 40%), vomiting (11% to 32%), diarrhea (11% to 30%), abdominal pain (7% to 20%), constipation (15%), anorexia (10% to 14%)
Hematologic: Anemia (27% to 48%), blood transfusion reaction (9% to 18%), leukopenia (15% to 17%), thrombocytopenia (6% to 13%)
Hepatic: Alkaline phosphatase increased (7% to 22%), bilirubinemia (?18%), ALT increased (15%), AST increased (13%), liver function tests abnormal (not specified) (4% to 13%)
Local: Phlebitis (9% to 11%)
Neuromuscular & skeletal: Weakness (6% to 13%), back pain (12%)
Renal: Nephrotoxicity (14% to 47%), creatinine increased (18% to 40%), BUN increased (7% to 21%), hematuria (14%)
Respiratory: Dyspnea (18% to 23%), lung disorder (14% to 18%), cough (2% to 18%), epistaxis (9% to 15%), pleural effusion (13%), rhinitis (11%)
Miscellaneous: Infusion reactions (4% to 21%), sepsis (7% to 14%), infection (11% to 13%)
2% to 10%:
Cardiovascular: Arrhythmia, atrial fibrillation, bradycardia, cardiac arrest, cardiomegaly, facial swelling, flushing, postural hypotension, valvular heart disease, vascular disorder, vasodilation
Central nervous system: Agitation, abnormal thinking, coma, depression, dysesthesia, dizziness (7% to 9%), hallucinations, malaise, nervousness, seizure, somnolence
Dermatologic: Alopecia, bruising, cellulitis, dry skin, maculopapular rash, petechia, purpura, skin discoloration, skin disorder, skin ulcer, urticaria, vesiculobullous rash
Endocrine & metabolic: Acidosis, fluid overload, hypernatremia (4%), hyperchloremia, hyperkalemia, hypermagnesemia, hyperphosphatemia, hypophosphatemia, hypoproteinemia, lactate dehydrogenase increased, nonprotein nitrogen increased
Gastrointestinal: Abdomen enlarged, amylase increased, dyspepsia, dysphagia, eructation, fecal incontinence, flatulence, gastrointestinal hemorrhage (10%), hematemesis, hemorrhoids, gum/oral hemorrhage, ileus, mucositis, rectal disorder, stomatitis, ulcerative stomatitis, xerostomia
Genitourinary: Vaginal hemorrhage
Hematologic: Coagulation disorder, hemorrhage, prothrombin decreased
Hepatic: Hepatocellular damage, hepatomegaly, veno-occlusive liver disease
Local: Injection site inflammation
Neuromuscular & skeletal: Arthralgia, bone pain, dystonia, myalgia, neck pain, paresthesia, rigors, tremor
Ocular: Conjunctivitis, dry eyes, eye hemorrhage
Renal: Abnormal renal function, acute renal failure, dysuria, renal failure, toxic nephropathy, urinary incontinence
Respiratory: Asthma, atelectasis, dry nose, hemoptysis, hyperventilation, pharyngitis, pneumonia, pulmonary edema, respiratory alkalosis, respiratory insufficiency, respiratory failure, sinusitis, hypoxia (6% to 8%)
Miscellaneous: Allergic reaction, cell-mediated immunological reaction, flu-like syndrome, graft-versus-host disease, herpes simplex, hiccup, procedural complication (8% to 10%), diaphoresis (7%)
Postmarketing and/or case reports: Agranulocytosis, angioedema, bronchospasm, cyanosis/hypoventilation, erythema, hemorrhagic cystitis
Drug Interactions
Aminoglycosides: Amphotericin B may enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): May diminish the therapeutic effect of Amphotericin B. Risk C: Monitor therapy
Colistimethate: Amphotericin B may enhance the nephrotoxic effect of Colistimethate. Risk D: Consider therapy modification
Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy
Corticosteroids (Systemic): May enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy
CycloSPORINE: Amphotericin B may enhance the nephrotoxic effect of CycloSPORINE. Risk C: Monitor therapy
CycloSPORINE, Systemic: Amphotericin B may enhance the nephrotoxic effect of CycloSPORINE, Systemic. Risk C: Monitor therapy
Flucytosine: Amphotericin B may enhance the adverse/toxic effect of Flucytosine. This may be related to the adverse effects of amphotericin B on renal function. Risk C: Monitor therapy
Gallium Nitrate: Amphotericin B may enhance the nephrotoxic effect of Gallium Nitrate. Risk X: Avoid combination
Saccharomyces boulardii: Antifungal Agents may diminish the therapeutic effect of Saccharomyces boulardii. Risk D: Consider therapy modification
Storage
Store intact vials at ?25°C (?77°F). Reconstituted vials are stable refrigerated at 2°C to 8°C (36°F to 46°F) for 24 hours. Do not freeze. Manufacturer's labeling states infusion should begin within 6 hours of dilution with D5W; data on file with Astellas Pharma shows extended formulation stability when admixed in D5W at 0.2-2 mg/mL (in polyolefin or PVC bags) for up to 11 days when stored refrigerated at 2°C to 8°C (36°F to 46°F).
Reconstitution
Reconstitute with 12 mL SWFI to a concentration of 4 mg/mL. The use of any solution other than those recommended, or the presence of a bacteriostatic agent in the solution, may cause precipitation. Shake the vial vigorously for 30 seconds, until dispersed into a translucent yellow suspension.
Filtration and dilution: The 5-micron filter should be on the syringe used to remove the reconstituted AmBisome®. Dilute to a final concentration of 1-2 mg/mL (0.2-0.5 mg/mL for infants and small children).
Compatibility
Stable in D5W; incompatible with NS, 1/2NS, other saline-containing solutions, or preservatives.
Y-site administration: Compatible: Anidulafungin
Mechanism of Action
Binds to ergosterol altering cell membrane permeability in susceptible fungi and causing leakage of cell components with subsequent cell death. Proposed mechanism suggests that amphotericin causes an oxidation-dependent stimulation of macrophages (Lyman, 1992).
Pharmacodynamics/Kinetics
Distribution: Vd: 131 L/kg
Half-life elimination: Terminal: 174 hours
Dosage
Usual dosage range:
Children ?1 month: I.V.: 3-6 mg/kg/day
Adults: I.V.: 3-6 mg/kg/day; Note: Higher doses (15 mg/kg/day) have been used clinically (Walsh, 2001)
Note: Premedication: For patients who experience nonanaphylactic infusion-related immediate reactions, premedicate with the following drugs 30-60 minutes prior to drug administration: A nonsteroidal anti-inflammatory agent ± diphenhydramine; or acetaminophen with diphenhydramine; or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered.
Indication-specific dosing:
Children ?1 month: I.V.:
Cryptococcal meningitis (HIV-positive): 6 mg/kg/day (may consider addition of oral flucytosine 25 mg/kg 4 times daily [unlabeled combination; AIDSinfo guidelines, 2008])
Empiric therapy: 3 mg/kg/day
Systemic fungal infections
(Aspergillus, Candida, Cryptococcus, Histoplasmosis)
: 3-5 mg/kg/day
General invasive Candidal disease: 3-5 mg/kg/day (may consider addition of oral flucytosine 25-37.5 mg/kg 4 times daily [unlabeled combination; AIDSinfo guidelines, 2008])
Candidal meningitis: 5 mg/kg/day; (may consider addition of oral flucytosine 25-37.5 mg/kg 4 times daily [unlabeled combination; AIDSinfo guidelines, 2008])
Histoplasmosis (unlabeled use): 3-5 mg/kg/day (AIDSinfo guidelines, 2008)
Visceral leishmaniasis:
Immunocompetent: 3 mg/kg/day on days 1-5, and 3 mg/kg/day on days 14 and 21; a repeat course may be given in patients who do not achieve parasitic clearance
Note: Alternate regimen of 10 mg/kg/day for 2 days has been reportedly effective.
Immunocompromised: 4 mg/kg/day on days 1-5, and 4 mg/kg/day on days 10, 17, 24, 31, and 38
Adults: I.V.:
Cryptococcal meningitis (HIV-positive): 6 mg/kg/day or 4-6 mg/kg/day in combination with addition of oral flucytosine 25 mg/kg 4 times daily (unlabeled combination; AIDSinfo guidelines, 2008)
Empiric candidiasis therapy: 3-5 mg/kg/day (Pappas, 2009)
Endocarditis: I.V.: 3-5 mg/kg/day (with or without flucytosine 25 mg/kg 4 times daily) for 6 weeks after valve replacement; Note: If isolates susceptible and/or clearance demonstrated, guidelines recommend step-down to fluconazole; also for long-term suppression therapy if valve replacement is not possible (Pappas, 2009)
Fungal sinusitis: Limited data in immunocompromised patients have shown efficacy with 3-10 mg/kg/day (Pagano, 2004; Rokicka, 2006; Barron, 2005). Note: An azole antifungal is recommended if causative organism is Aspergillus spp or Pseudallescheria boydii (Scedosporium sp).
Osteoarticular candidiasis: I.V.: 3-5 mg/kg/day for several weeks, followed by fluconazole for 6-12 months (osteomyelitis) or 6 weeks (septic arthritis)
Systemic fungal infections
(Aspergillus, Candida, Cryptococcus, Histoplasmosis)
: 3-5 mg/kg/day
General invasive Candidal disease: 3-5 mg/kg/day with oral flucytosine 25 mg/kg 4 times daily (unlabeled combination; Pappas, 2009)
Candidal meningitis: 3-5 mg/kg/day with or without oral flucytosine 25 mg/kg 4 times daily (unlabeled combination; Pappas, 2009)
Histoplasmosis (unlabeled use): 3-5 mg/kg/day (AIDSinfo guidelines, 2008)
Visceral leishmaniasis:
Immunocompetent: 3 mg/kg/day on days 1-5, and 3 mg/kg/day on days 14 and 21; a repeat course may be given in patients who do not achieve parasitic clearance
Note: Alternate regimen of 2 mg/kg/day for 5 days has been reportedly effective.
Immunocompromised: 4 mg/kg/day on days 1-5, and 4 mg/kg/day on days 10, 17, 24, 31, and 38
Dosing adjustment in renal impairment: None necessary; effects of renal impairment are not currently known
Hemodialysis: No supplemental dosage necessary
Peritoneal dialysis effects: No supplemental dosage necessary
Continuous renal replacement therapy (CRRT): No supplemental dosage necessary
Administration: I.V.
Intravenous infusion, over a period of approximately 2 hours. Infusion time may be reduced to approximately 1 hour in patients in whom the treatment is well-tolerated. If the patient experiences discomfort during infusion, the duration of infusion may be increased. Discontinue if severe respiratory distress occurs.
For a patient who experiences chills, fever, hypotension, nausea, or other nonanaphylactic infusion-related reactions, premedicate with the following drugs, 30-60 minutes prior to drug administration: A nonsteroidal (eg, ibuprofen, choline magnesium trisalicylate) with or without diphenhydramine or acetaminophen with diphenhydramine or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered.
Administration: I.V. Detail
Existing intravenous line should be flushed with D5W prior to infusion (if not feasible, administer through a separate line). An in-line membrane filter (not less than 1 micron) may be used.
Monitoring Parameters
Renal function (monitor frequently during therapy), electrolytes (especially potassium and magnesium), liver function tests, temperature, PT/PTT, CBC; monitor input and output; monitor for signs of hypokalemia (muscle weakness, cramping, drowsiness, ECG changes, etc); monitor cardiac function if used concurrently with corticosteroids
Patient Education
Do not take any new medication during therapy unless approved by prescriber. This medication can only be administered by infusion and therapy may last several weeks. You will be monitored closely during and after infusion; report immediately any pain or swelling at infusion site, difficulty breathing or chest pain, chills, nausea, swelling of face or mouth, muscle cramping, acute anxiety, or other infusion reactions. Maintain adequate hydration unless instructed to restrict fluid intake. You may experience dizziness, anxiety, or confusion (request assistance/use caution when getting up or changing position and do not perform activities requiring alertness [including driving] until response to drug is known) or nausea, vomiting, or loss of appetite (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help). Report chest pain or palpitations; CNS disturbances; skin rash; unusual chills or fever; persistent nausea, vomiting, or abdominal pain; sore throat; excessive fatigue; swelling of extremities or unusual weight gain; difficulty breathing; muscle cramping or weakness; or other adverse reactions. Breast-feeding precaution: Do not breast-feed.
Additional Information
Amphotericin B (liposomal) is a true single bilayer liposomal drug delivery system. Liposomes are closed, spherical vesicles created by mixing specific proportions of amphophilic substances such as phospholipids and cholesterol so that they arrange themselves into multiple concentric bilayer membranes when hydrated in aqueous solutions. Single bilayer liposomes are then formed by microemulsification of multilamellar vesicles using a homogenizer. Amphotericin B (liposomal) consists of these unilamellar bilayer liposomes with amphotericin B intercalated within the membrane. Due to the nature and quantity of amphophilic substances used, and the lipophilic moiety in the amphotericin B molecule, the drug is an integral part of the overall structure of the amphotericin B liposomal liposomes. Amphotericin B (liposomal) contains true liposomes that are <100 nm in diameter.
Anesthesia and Critical Care Concerns/Other Considerations
Clinical Pearls/Comments:
Prevention of infusion-related reactions: Patients may be premedicated with acetaminophen 650 mg and diphenhydramine 25-50 mg 30 minutes prior to infusion. Hydrocortisone can be used if patient has experienced rigors with amphotericin in the past. Meperidine can also be used for the treatment of rigors during the infusion.
This product is significantly more expensive than conventional amphotericin B; Infectious Disease consult is recommended. AmBisome® is a true single bilayer liposomal drug delivery system. Liposomes are closed, spherical vesicles created by mixing specific proportions of amphophilic substances such as phospholipids and cholesterol so that they arrange themselves into multiple concentric bilayer membranes when hydrated in aqueous solutions. Single bilayer liposomes are then formed by microemulsification of multilamellar vesicles using a homogenizer. AmBisome® consists of these unilamellar bilayer liposomes with amphotericin B intercalated within the membrane. Due to the nature and quantity of amphophilic substances used, and the lipophilic moiety in the amphotericin B molecule, the drug is an integral part of the overall structure of the AmBisome® liposomes. AmBisome® contains true liposomes that are <100 nm in diameter.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Facial swelling, postural hypotension, mucositis, stomatitis, and ulcerative stomatitis (see Dental Health Professional Considerations)
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Dental Comment
Amphotericin B, liposomal is a true single bilayer liposomal drug delivery system. Liposomes are closed, spherical vesicles created by mixing specific proportions of amphophilic substances such as phospholipids and cholesterol so that they arrange themselves into multiple concentric bilayer membranes when hydrated in aqueous solutions. Single bilayer liposomes are then formed by microemulsification of multilamellar vesicles using a homogenizer. Amphotericin B, liposomal consists of these unilamellar bilayer liposomes with amphotericin B intercalated within the membrane. Due to the nature and quantity of amphophilic substances used, and the lipophilic moiety in the amphotericin B molecule, the drug is an integral part of the overall structure of the amphotericin B liposomes. Amphotericin B, liposomal contains true liposomes that are <100 nm in diameter.
Mental Health: Effects on Mental Status
Sedation is common; may cause delirium
Mental Health: Effects on Psychiatric Treatment
May cause bone marrow suppression; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Assess culture and sensitivity report and patient's previous exposure to Amphotericin B prior to starting therapy. Assess all other pharmacological or herbal products patient may be taking for potential interactions or toxicity (eg, other nephrotoxic drugs). See Administration for infusion specifics and premedication recommendations. Patient should be monitored closely for infusion-related reactions (eg, anaphylaxis, chills, fever, nausea, vomiting, rigors, hypotension, acute respiratory distress); facilities for cardiopulmonary resuscitation should be available during infusion. If acute respiratory distress occurs, infusion should be stopped and prescriber notified. Evaluate results of laboratory tests, therapeutic effectiveness, and adverse response frequently during therapy. Teach patient possible side effects/appropriate interventions and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, powder for reconstitution:
AmBisome®: 50 mg [contains soy and sucrose]
References
Barron MA, Lay M, Madinger NE, “Surgery and Treatment with High-Dose Liposomal Amphotericin B for Eradication of Craniofacial Zygomycosis in a Patient with Hodgkin's Disease Who Had Undergone Allogeneic Hematopoietic Stem Cell Transplantation,” J Clin Microbiol, 2005, 43(4):2012-14.
Edwards JE Jr, Bodey GP, Bowden RA, et al, “International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections,” Clin Infect Dis, 1997, 25(1):43-59.
Eggimann P, Francioli P, Bille J, et al, “Fluconazole Prophylaxis Prevents Intra-abdominal Candidiasis in High-Risk Surgical Patients,” Crit Care Med, 1999, 27(6):1066-72.
Emminger W, Graninger W, Emminger-Schmidmeir W, et al, “Tolerance of High Doses of Amphotericin B by Infusion of a Liposomal Formulation in Children With Cancer,” Ann Hematol, 1994, 68:27-31.
Fichtenbaum CJ, Zackin R, Rajicic N, et al, “Amphotericin B Oral Suspension for Fluconazole-Refractory Oral Candidiasis in Persons With HIV Infection. Adult AIDS Clinical Trials Group Study Team 295,” AIDS, 2000, 14(7):845-52.
“Guidelines for Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children,” June 20, 2008. Available at http://aidsinfo.nih.gov
“Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents,” June 18, 2008. Available at http://aidsinfo.nih.gov
Hiemenz JW and Walsh TJ, “Lipid Formulations of Amphotericin B: Recent Progress and Future Directions,” Clin Infect Dis, 1996, 22(Suppl 2):133-44.
Lyman CA and Walsh TJ, “Systemically Administered Antifungal Agents. A Review of Their Clinical Pharmacology and Therapeutic Applications,” Drugs, 1992, 44(1):9-35.
Mora-Duarte J, Betts R, Rotstein C, et al, “Comparison of Caspofungin and Amphotericin B for Invasive Candidiasis,” N Engl J Med, 2002, 347(25):2020-9.
Pagano L, Offidani M, Fianchi L, et al, “Mucormycosis in Hematologic Patients,” Haematologica, 2004, 89(2):207-14.
Pappas PG, Kauffman CA, Andes D, et al, “Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America,” Clin Infect Dis, 2009, 48(5):503-35.
Patel R, “Antifungal Agents. Part I. Amphotericin B Preparations and Flucytosine,” Mayo Clin Proc, 1998, 73(12):1205-25.
Rex JH, Bennett JE, and Sugar AM, “A Randomized Trial Comparing Fluconazole With Amphotericin B for the Treatment of Candidemia in Patients Without Neutropenia. Candidemia Study Group and the National Institute,” N Engl J Med, 1994, 331(20):1325-30.
Rex JH, Pappas PG, Karchmer AW, et al, “A Randomized and Blinded Multicenter Trial of High-Dose Fluconazole Plus Placebo Versus Fluconazole Plus Amphotericin B as Therapy for Candidemia and Its Consequences in Nonneutropenic Subjects,” Clin Infect Dis, 2003, 36(10):1221-8.
Rex JH, Walsh TJ, Sobel JD, et al, “Practice Guidelines for the Treatment of Candidiasis. Infectious Diseases Society of America,” Clin Infect Dis, 2000, 30(4):662-78.
Ringden O, Andstrom E, Remberger M, et al, “Safety of Liposomal Amphotericin B (AmBisome®) in 187 Transplant Recipients Treated With Cyclosporin,” Bone Marrow Transplant, 1994, 14(Suppl 5):10-4.
Rokicka M, “AmBisome® Treatment of Fungal Sinusitis in Severe Immunocompromised Patient With Acute Lymphoblastic Leukemia Relapsed after Autologous Peripheral Blood Transplantation,” ACTA Biomed, 2006, 77(Suppl 2):26-7.
Slain D, “Lipid-Based Amphotericin B for the Treatment of Fungal Infections,” Pharmacotherapy, 1999, 19(3):306-23.
Walsh TH, Goodman JL, Pappas P, et al, “Safety, Tolerability, and Pharmacokinetics of High-Dose Liposomal Amphotericin B (AmBisome) in Patients Infected With Aspergillus Species and Other Filamentous Fungi: Maximum Tolerated Dose Study,” Antimicrob Agents Chemother, 2001, 45(12):3487-96.
Walsh TJ, Finberg RW, Arndt C, et al, “Liposomal Amphotericin B for Empirical Therapy in Patients With Persistent Fever and Neutropenia,” N Engl J Med, 1999, 340:764-71.
International Brand Names
Lexi-Comp.com
Last full review/revision January 2010
Content last modified January 2010
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