AlternativeAmBisome
Amphotericin B (liposomal)
Polyene antifungal
Reserved for invasive/systemic fungal infection refractory to azoles.
IV
First-line for
- Invasive candidiasis refractory to fluconazole
- Cryptococcal meningitis in pregnancy
- Systemic aspergillosis
Mechanism
Binds ergosterol in fungal membrane → forms pores → cell death. Liposomal form ↓ nephrotoxicity.
“Shake & bake” — infusion reactions
- Premedicate: paracetamol ± hydrocortisone
- Liposomal preferred — less nephrotox
Dosing
- Liposomal
- 3–5 mg/kg IV OD
Contraindications
- AbsoluteHypersensitivity to amphotericin
- CautionSevere renal impairment
Side effects
- Infusion reaction (fever, rigors)
- Nephrotoxicity
- Hypokalaemia, hypomagnesaemia
- Anaemia
Fetal & maternal notes
- • No structural teratogenicity reported
- • Use when benefit clearly outweighs risk — life-threatening fungal disease only
Key interactions
Aminoglycosides
AvoidAdditive nephrotoxicity
Diuretics
Caution↑ hypokalaemia
Digoxin
CautionToxicity if hypoK
Clinical pearls
- 💡 Liposomal preferred in pregnancy — better safety
- 💡 Monitor U&E and Mg daily
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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