Amphotericin B Formulations and Usage Guidelines

Introduction to Formulations

The American College of Physicians and Infectious Diseases Society of America recommend considering the differences between conventional amphotericin B deoxycholate and liposomal amphotericin B, which differ fundamentally in formulation, dosing, toxicity profile, and cost 1, 2

The National Comprehensive Cancer Network recommends dosing conventional amphotericin B deoxycholate at 0.6–1.0 mg/kg per day, while lipid-associated formulations, including liposomal, are dosed at 3–5 mg/kg per day 1, 2, 3

The Kidney Disease: Improving Global Outcomes guidelines provide a Grade 1A recommendation to use azole antifungals and/or echinocandins rather than conventional amphotericin B when equal therapeutic efficacy can be assumed, due to the high risk of nephrotoxicity in the majority of patients 5
Lipid formulations are particularly important for patients at high risk for renal failure, including those with pre-existing renal disease, transplant recipients, and patients receiving other nephrotoxic agents 3

Both formulations are equally effective when used at appropriate dosages for invasive fungal infections, according to the Infectious Diseases Society of America 1, 2

The National Comprehensive Cancer Network guidelines recommend hydration with 0.9% saline intravenously 30 minutes before infusion to ameliorate nephrotoxicity, as well as monitoring serum creatinine and electrolytes at minimum once or twice weekly 4, 5, 6
Avoiding concomitant nephrotoxic medications and using the lowest effective dose and shortest duration of therapy are also recommended 4, 5, 6