兩性黴素B

用途

• Susceptible systemic fungal infections (Llama)
• Susceptible systemic fungal infections (Rapid-Infusion Technique)
• Susceptible systemic fungal infections (Slow IV Infusion Technique)
• Systemic fungal infections (Dehydrated/compromised)
• Systemic mycoses (Lipid-based: AmBisome, Amphocil, Abelcet)
• Systemic mycoses (ABLC; Abelcet)
• Blastomycosis
• Blastomycosis
• Blastomycosis (severe cases, using Abelcet)
• Cryptococcosis
• Histoplasmosis
• Histoplasmosis
• Leishmaniasis (Liposomal form)

給藥方式

可能的副作用

• Nephrotoxicity (very common, dose-dependent)
• Anorexia and vomiting
• Hypokalemia and hypomagnesemia
• Distal renal tubular acidosis
• Phlebitis at injection site
• Cardiac arrhythmias
• Non-regenerative anemia
• Fever (can be mitigated with NSAIDs or low-dose steroids)
• Tachycardia, tachypnea, lethargy, restlessness (horses)
• Calcinosis cutis (dogs)

注意事項與禁忌

• Patients with known hypersensitivity to amphotericin B (unless the infection is life-threatening and no alternatives exist)
• > **Black Box Warning Equivalent:** Amphotericin B is highly nephrotoxic. Renal function must be aggressively monitored during therapy. - Use with extreme caution in patients with pre-existing renal disease. - Cats are more sensitive to nephrotoxic effects; reduced dosages are often recommended. - Ensure adequate hydration prior to administration. Sodium loading (e.g., normal saline administration before and after dosing) may help avert renal insufficiency by preventing tubuloglomerular feedback-induced vasoconstriction. - Pregnancy: Weigh risks vs. benefits. FDA Category B (human); Papich Class A (veterinary).

藥物相互作用

• Corticosteroids: May exacerbate the potassium-losing effects of amphotericin B.
• Digoxin: Amphotericin B-induced hypokalemia may exacerbate digoxin toxicity.
• Flucytosine: In vitro synergy against Cryptococcus and Candida, but may also increase flucytosine toxicity.
• Nephrotoxic Drugs (Aminoglycosides, Polymyxin B, Cisplatin, Cyclosporine, etc.): Additive renal toxicity; avoid concurrent or sequential use if possible.
• Potassium-Depleting Drugs (Thiazide or Loop Diuretics): Increased risk of severe hypokalemia.
• Saline Solutions or Preservative-containing Solutions: Reconstituting amphotericin B deoxycholate with these solutions may cause precipitation.
• Skeletal Muscle Relaxants (Tubocurarine): Amphotericin B-induced hypokalemia may enhance curariform effects.
• Fluorouracil: Amphotericin may increase the toxic effects of fluorouracil.
• Doxorubicin: Amphotericin may increase the toxic effects of doxorubicin.
• Methotrexate: Amphotericin may increase the toxic effects of methotrexate.

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