Amphotericin B (Atc Code J02AA01)
When ATH:
J02AA01
Amphotericin B – Characteristic
Polyene antibiotics, producyruemy aktinomicetom Streptomyces nodosus. The powder is yellow or yellow-orange. Practically insoluble in water, ether, ethanol, xloroforme. Hygroscopic, sensitive to light and heat. Easy inactivated in acidic and alkaline media.
Amphotericin B – Pharmacological action
Antifungal, fungicidnoe.
Amphotericin B-Application
Systemic mikozy kandidomikoz —, aspergillosis, histoplasmosis, kryptokokkoz, coccidiomycosis, blastomycosis, pulmonary fungal infections (actinomycosis), cystitis, leishmaniasis.
Amphotericin B – Contraindications
Hypersensitivity, expressed human liver and kidneys, diseases of the hematopoietic system, diabetes.
Amphotericin B – Restrictions apply
Pregnancy, lactation.
Amphotericin B – Pregnancy and breast-feeding
Be wary of pregnancy (adequate and well-controlled studies of the safety of use in pregnant women were not conducted).
Category actions on the fetus by the FDA — B. (The study of reproduction in animals revealed no risk of adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not done.)
At the time of treatment should stop breastfeeding (unknown, whether the amphotericin b in breast milk).
Amphotericin B – Side effects
From the nervous system and sensory organs: headache, polyneuropathy, blurred vision, diplopia.
Cardio-vascular system and blood (hematopoiesis, hemostasis): arterïalnaya hypo- or giperteziya, arrhythmia, ECG changes, anemia, leukopenia, thrombocytopenia.
From the digestive tract: nausea, vomiting, diarrhea, epigastric pain, loss of appetite, increase in liver enzymes.
With the genitourinary system: impairment of renal function, incl. increased concentration of serum creatinine, proteinuria, azotemia, Acidosis.
Allergic reactions: skin rash, itch, angioedema, bronchospasm (inhalation).
Other: fever, chills, violation of the electrolyte composition of blood, incl. kaliopenia, gipomagniemiya; thrombophlebitis at the injection site; When the inhalation is a Tickle in the throat, cough, cold; the local application is possible allergic reactions.
Amphotericin B – Cooperation
Can enhance the effect of cardiac glycosides, and muscle relaxants curariform. Incompatible with nephrotoxic antibiotics and anticancer drugs.
Amphotericin B – Overdose
Symptoms: increased side effects, possible cardiac arrest and respiratory.
Treatment: symptomatic.
Amphotericin B – Dosing and Administration
B /, inhalation and locally (as an ointment). To determine the tolerability the initial dose for the on/in the introduction is 100 ug / kg body weight. The dose is determined individually, depending on the nature of the disease, efficacy and tolerability; the average dose is 250 mg / kg, if necessary (and good endurance) the increase in the daily dose of up to 1 mg / kg. Assign a day or 2 times a week. The duration of treatment depends on the severity and localization process, duration of the disease, etc.. and is not less than 4-8 weeks (to prevent recurrence).
Inhalation-solution prepared immediately before use, the rate of 50000 ED 10 ml of sterile water for injection. Inhalation out 1-2 times daily for a period of 15-20-min. When using inhalers, working only on inspiration, single dose to 5 ml (25000 ED). The course of treatment is 10-14 days, Refresh course — over 7-10 days.
Locally, Ointment applied thinly on the surface of the lesions 1-2 times a day (to 4 time). The course of treatment - at least 10 days.
Amphotericin B – Precautions
To reduce the severity of side effects appoint antipyretics and antihistamines, B vitamins, ascorbic acid, NSAIDs, iron supplements, potassium, etc.. During treatment requires systematic monitoring of renal function, liver, and the blood level of potassium in the blood. If you have symptoms of anemia treatment with amphotericin B should be discontinued. For better portability antibiotic solution for inhalation it is recommended to add 10-15 drops of glycerin health.
Amphotericin B – Cooperation
| Active substance | Description of interaction |
| Altretamïn | FMR. If concomitant use increases the risk of kidney damage and the likelihood of hypotension and bronchospasm. |
| Amikacin | FMR: synergism. Strengthens (mutually) The risk of developing nephrotoxicity. |
| Anastrozol | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Asparaginase | FMR. If concomitant use increases the risk of kidney damage and the likelihood of hypotension and bronchospasm. |
| Atrakuriya besilate | FMR: synergism. Against the background of amphotericin B and the resulting effect is enhanced by hypokalemia. |
| Bikalutamid | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Bleomycin | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Busulfan | FMR. Against the background of amphotericin B increases the risk of bronchospasm and hypotension; may affect the kidneys. |
| Vancomycin | FMR. Strengthens (mutually) The risk of developing neurons, th- and nephrotoxicity. |
| Vekuroniya bromide | FMR: synergism. Against the background of amphotericin B and the resulting effect is enhanced by hypokalemia. |
| Vynorelbyn | FMR. In a joint application increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Ganciclovir | FMR. In a joint application increases the risk of kidney damage, increases in serum creatinine. |
| Gemcitabine | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Gentamicin | FMR. Strengthens (mutually) The risk of developing nephrotoxicity. |
| Gidrokortizon | FMR. It increases the likelihood of hypokalemia, aritmii, dilatation of myocardial injury and heart failure. |
| Dakarʙazin | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Daunorubicin | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Digoxin | FMR. Increases (mutually) the risk of toxicity (possibly as a consequence of increasing hypokalemia). |
| Doxorubicin | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Docetaxel | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Zidovudine | FMR: synergism. Strengthens (mutually) the risk of bone marrow, It increases the likelihood of renal impairment. |
| Idaruʙiцin | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Interferon alfa-2a | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Interferon alfa-2b, recombinant human | FMR. If concomitant use increases the risk of kidney damage and the likelihood of hypotension and bronchospasm. |
| Irinotecan | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Ifosfamid | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Kanamycin | FMR: synergism. Strengthens (mutually) The risk of developing nephrotoxicity. |
| Carboplatin | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Karmustin | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Kortizon | FMR. It increases the likelihood of hypokalemia and arrhythmia. |
| Levamisole | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Lomustin | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Megestrol | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Melfalane | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Merkaptopurin | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Methylprednisolone | FMR. It increases the likelihood of hypokalemia and arrhythmia. |
| Methotrexate | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Mikonazol | FMR: antagonizm. Weakens effect: It inhibits the synthesis of sterols and membranes of the cytoplasmic membrane of fungi, depriving, thereby, amphotericin B binding sites. |
| Mytoksantron | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Mitomycin | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Paclitaxel | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Prednisolone | FMR: synergism. It increases the likelihood of hypokalemia and arrhythmia. |
| Procarbazine | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Rokuroniya bromide | FMR: synergism. Against the background of amphotericin B and the resulting effect is enhanced by hypokalemia. |
| Streptomycin | FMR. Strengthens (mutually) The risk of developing nephrotoxicity. |
| Tamoxifen | FMR: synergism. Combined use increases the risk of kidney damage and the likelihood of hypotension and bronchospasm. |
| Tobramycin | FMR: synergism. Strengthens (mutually) The risk of developing nephrotoxicity. |
| Topotecan | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Toremifene | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Triamcinolone | FMR: synergism. It increases the likelihood of hypokalemia and arrhythmia. |
| Fludrokortizon | FMR. It increases the likelihood of hypokalemia and associated side effects (Arrhythmia). |
| Fluconazole | FMR: antagonizm. Weakens effect: It inhibits the synthesis of sterols and membranes of the cytoplasmic membrane of fungi, depriving, thereby, amphotericin B binding sites. |
| Flutamid | FMR: synergism. If concomitant use increases the risk of kidney damage and the likelihood of hypotension and bronchospasm. |
| Khlorambutsil | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Cyclosporine | FMR. If concomitant use increases the risk of kidney damage. |
| Cyclophosphamide | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Cisplatin | FMR. When combined with the use of amphotericin B increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Exemestane | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Epirubicin | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Estramustine | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
| Etoposide | FMR. If concomitant use increases the risk of kidney damage and increases the likelihood of developing bronchospasm and hypotension. |
