Side Effects of Liposomal Amphotericin B

Introduction to Side Effects

The Infectious Diseases Society of America recommends that liposomal amphotericin B is substantially better tolerated than conventional amphotericin B deoxycholate, with significantly reduced nephrotoxicity and fewer infusion-related reactions, though these adverse events still occur and require monitoring 1, 2

Acute infusion-related reactions occur in approximately 20% of patients receiving liposomal amphotericin B, which is significantly lower than the 44-54% seen with conventional amphotericin B, according to the Centers for Disease Control and Prevention 3, 4, 5
The American College of Physicians notes that severe acute reactions can include chest pain, dyspnea, hypoxia, severe abdominal/flank/leg pain, flushing, and urticaria 3, 4, 5
Premedication with diphenhydramine can reduce the incidence of infusion-related reactions, as suggested by the Centers for Disease Control and Prevention 3, 4, 5

Nephrotoxicity occurs in patients receiving liposomal amphotericin B, manifesting as electrolyte abnormalities, particularly hypokalemia and hypomagnesemia, according to the European Society of Clinical Microbiology and Infectious Diseases 1, 2, 9
The National Institutes of Health recommends baseline and frequent serum chemistry monitoring, including creatinine, BUN, potassium, and magnesium, to prevent and monitor nephrotoxicity 1, 2, 10

Anemia can occur with liposomal amphotericin B therapy, though less frequently than with conventional formulations, according to the Infectious Diseases Society of America 1, 2
Regular CBC monitoring is recommended by the American College of Physicians to detect hematologic effects 1, 2, 10

Elevated aminotransferase levels may occur, and regular liver function monitoring is advised by the European Association for the Study of the Liver 10

The FDA recommends that liposomal amphotericin B is considered probably compatible during pregnancy and breastfeeding, though interruption of breastfeeding may be prudent, as noted by the Infectious Diseases Society of America 1, 2

Baseline and ongoing laboratory monitoring must include serum chemistry, complete blood count, liver function tests, and urinalysis, as recommended by the National Institutes of Health 1, 2, 10