Amphotericin B is indicated for the following conditions:

• Empirical treatment of suspected fungal infections in febrile neutropenic patients
• Management of cryptococcal meningitis in patients with HIV infection
• Treatment of severe infections caused by Aspergillus, Candida, and Cryptococcus species, especially in cases resistant to amphotericin B deoxycholate or when its use is limited due to renal impairment or toxicity
• Treatment of visceral leishmaniasis (with higher relapse rates observed in immunocompromised patients after initial response)

Amphotericin B exhibits fungistatic or fungicidal activity depending on drug concentration and fungal susceptibility. It works by binding to ergosterol in the fungal cell membrane, forming pores that increase membrane permeability. This leads to leakage of essential intracellular components and ultimately causes fungal cell death. As a polyene antifungal, Amphotericin B binds strongly and irreversibly to ergosterol, disrupting membrane integrity.

Systemic Fungal Infections

• Test dose: 1 mg IV infused over 20-30 min
• Load: 0.25-0.5 mg/kg IV infused over 2-6 hour
• Maintenance: 0.25-1 mg/kg IV qDay OR up to 1.5 mg/kg IV every other day (may increase gradually by 0.25 mgincrements/day)

Co-administration of Amphotericin B with flucytosine may increase toxicity. The risk of kidney damage is higher when used with other nephrotoxic drugs. It may also reduce the effectiveness of azole antifungal agents.

Amphotericin B should not be used in patients with known hypersensitivity to amphotericin B deoxycholate or any component of the formulation, unless the potential benefit outweighs the risk as determined by the physician.

Common adverse effects include fever, chills, malaise, and convulsions. Gastrointestinal symptoms such as nausea, vomiting, diarrhea, and loss of appetite may occur. Other effects include tinnitus, vertigo, hearing impairment, blood pressure changes, cardiac arrhythmias, peripheral neuropathy, injection site pain, phlebitis, and kidney dysfunction including nephrotoxicity.

Pregnancy Category B. There are no well-controlled studies in pregnant women. It is not known whether Amphotericin B is excreted into breast milk, so caution is advised during lactation.

This medication should be administered by trained healthcare professionals. Patients should be closely monitored, especially during the initial phase of treatment. Although less toxic than amphotericin B deoxycholate, adverse reactions may still occur.

Other antifungal preparations.

Unopened vials should be stored at temperatures up to 25°C. After reconstitution, the solution may be stored at 2–8°C for up to 24 hours.