Dental Concerns

See also Dental Concerns for Amphetamines and Derivatives.

Amphotericin B (Deoxycholate)

[am-foe-TER-ih-sin] Pregnancy Category: B

Amphotec, Fungizone M, Fungizone Intravenous (Rx)

Amphotericin B Lipid Complex (Amphotericin B Cholesteryl Sulfate Complex)

[am-foe-TER-ih-sin] Pregnancy Category: B

Abelcet, AmBisome, Amphotec (Rx) Classification: Antibiotic, antifungal

See also Anti-Infectives. Action/Kinetics: This antibiotic is produced by Streptomyces nodosus; it is fungistatic or fungicidal depending on the concentration of the drug in body fluids and the susceptibility of the fungus. Amphotericin B binds to specific chemical structures—sterols—of the fungal cellular membrane, increasing cellular permeability and promoting loss of potassium and other substances. Liposomal encapsulation or incorporation in a lip-id complex can significantly affect the functional properties of the drug compared with those of the unen-capsulated or non-lipid-associated drug. The liposomal amphotericin B product causes less nephrotoxicity. Amphotericin B is used either IV or topically. It is highly bound to serum protein (90%) Peak plasma levels: 0.5-2 mcg/mL. tV2, initial: 24 hr; second phase: 15 days. Slowly excreted by kidneys. The kinetics of

AMPHOTERICIN B

the drug differ in adults and children.

Uses: The drug is toxic and should be used only for clients under close medical supervision with progressive or potentially fatal fungal infections. Systemic: Amphotericin B de-oxycholate: Disseminated North American blastomycosis, cryptococcosis, and other systemic fungal infections, including coccidioidomycosis, histoplasmosis, mucormycosis, spor-otrichosis, aspergillosis, disseminated candidiasis, and monilial overgrowth resulting from oral antibiotic therapy. Secondary therapy to treat American mucocutaneous leishma-niasis. Liposomal Amphotericin b: Aspergillosis in clients refractory to or intolerant of conventional amphoter-icin B therapy. Non-FDA Approved Uses: Prophylaxis of fungal infections in clients with bone marrow transplantation. Topical: Cutaneous and mucocutaneous infections of Candida (Monilia) infections, especially in children, adults, and AIDS clients with thrush.

Contraindications: Hypersensitiv-ity to drug unless the condition is life-threatening and amenable only to amphotericin B therapy. Use to treat common forms of fungal diseases showing only positive skin or serologic tests. Use to treat noninva-sive forms of fungal disease such as oral thrush, vaginal candidiasis, and esophageal candidiasis in clients with normal neutrophil counts. Lactation.

Special Concerns: The bone marrow depressant effects may result in increased incidence of microbial infection, delayed healing, and gingival bleeding. Although used in children, safety and efficacy have not been determined. Use with caution in clients receiving leukocyte transfusions.

Side Effects: After topical use. Irritation, pruritus, dry skin. Redness, itching, or burning especially in skin folds. After IV use. Acute reactions occurring 1 to 3 hr after starting IV in fusion: Fever, hypotension, shaking chills, hypotension, anorexia, N&V, headache, tachypnea. Rapid infusion may cause hypotension, hypoka-lemia, arrhythmias, and shock. Oral: stomatitis. GI: N&V, diarrhea, dyspepsia, anorexia, abdominal cramps, epigastric pain, melena; rarely, GI disorder, GI hemorrhage, hemateme-sis, dyspepsia, enlarged abdomen, hepatomegaly, cholangitis, cholecystitis, hemorrhagic gastroenteritis, acute liver failure, hepatitis, jaundice, veno-occlusive liver disease, hepatic failure. CNS: Fever, chills, headache, depressoin, abnormal thinking, malaise, vertigo, leukoen-cephalopathy; rarely, dizziness, somnolence, agitation, stupor, tremor, anxiety, paresthesia, hallucinations, seizures, encephalopathy, extrapyramidal symptoms, peripheral neuropathy, and other neurologic symptoms. Respiratory: Respiratory disorder, pneumonia, respiratory failure. Acute dyspnea, hypoxia, epistaxis, increased cough, lung disorder, hemoptysis, hyperventilation, hyper-sensitivity pneumonitis, apnea. Interstitial infiltrates seen in neutro-penic clients receiving amphotericin B and leukocyte transfusions. CV: Thrombophlebitis, hypotension, hypertension, tachycardia, tachypnea, phlebitis. Rarely, arrhythmias, phlebitis, syncope, ventricular extrasystoles, postural hypotension, supra-ventricular tachycardia, thrombophlebitis, pleural effusion, hemoptysis, atrial fibrillation, bradycardia, CHF, ventricular fibrillation, cardiac arrest, cardiac failure, shock, hemorrhage, pulmonary embolus, MI, cardiomyo-pathy. Renal: Renal damage (including tubular dysfunction), azotemia, hyposthenuria, nephrocalcinosis, renal tubular acidosis, kidney failure; rarely, acute renal failure, decreased renal function, anuria, oliguria, hem-aturia, dysuria, infection. Hemato-logic: Normochromic, normocytic anemia; anemia, coagulation disorder. Rarely, coagulation defects, thrombocytopenia, leukopenia, ag-

106 AMPHOTERICIN B

Dranulocytosis, eosinophilia, leukocy-tosis, hypochromic anemia, blood dyscrasias. Dermatologic: Maculo-papular rash, pruritus, rash; rarely, exfoliative dermatitis, erythema multiforme, skin disorder. Hypersensit-vity: Rarely, bronchospasm, asthma, anaphylactoid reactions, wheezing. Ophthalmic/Otic: Rarely, tinnitus, hearing loss, blurred vision, eye hemorrhage, diplopia, impaired vision. At injection site: Venous pain with phlebitis and thrombophlebitis. Miscellaneous: Muscle and joint pain, weight loss, infection, sweating, pain, chest pain, back pain, multiple organ failure, sepsis, face edema, asthenia, peripheral edema, mucous membrane disorder; rarely, flushing, impotence, myasthenia, arthral-gia, myalgia, After intrathecal use:

Blurred vision, changes in vision, difficulty in urination, numbness, tingling, pain, or weakness.

Drug Interactions Corticosteroids / T Potassium depletion caused by amphotericin B ^ cardiac dysfunction Skeletal muscle relaxants, surgical (e.g., succinylcholine, d-tubocu-rarine) / T Muscle relaxation due to amphotericin B-induced hypokale-mia

How Supplied: Cream: 3%; Lotion: 3%; Powder for injection: 50 mg

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