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Amphotericin B deoxycholate (conventional): Drug

information

Copyright 1978-2021 Lexicomp, Inc. All rights reserved.

(For additional information see "Amphotericin B deoxycholate (conventional): Patient drug information" and see
"Amphotericin B deoxycholate (conventional): Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp ( show table)

ALERT: US Boxed Warning

Appropriate use:

This drug should be used primarily for treatment of patients with progressive and
potentially life-threatening fungal infections; it should not be used to treat noninvasive
forms of fungal disease such as oral thrush, vaginal candidiasis, and esophageal
candidiasis in patients with normal neutrophil counts.

Error prevention:

Exercise caution to prevent inadvertent overdose with amphotericin B. Verify the product
name and dosage if dose exceeds 1.5 mg/kg.

Brand Names: Canada

Fungizone IV

Pharmacologic Category
Antifungal Agent, Parenteral

Dosing: Adult
Note: Conventional amphotericin formulations (desoxycholate [Amphocin, Fungizone]) may be
confused with lipid-based formulations (AmBisome, Abelcet, Amphotec). Lipid-based and
conventional formulations are not interchangeable and have different dosage
recommendations. Overdoses have occurred when conventional formulations were dispensed
inadvertently for lipid-based products.

Note: Premedication: For patients who experience infusion-related immediate reactions,

premedicate with the following drugs 30 to 60 minutes prior to drug administration: NSAID
and/or diphenhydramine or acetaminophen with diphenhydramine or hydrocortisone. If
the patient experiences rigors during the infusion, meperidine may be administered.

Test dose: IV: 1 mg infused over 20 to 30 minutes. Many clinicians believe a test dose is
unnecessary.

Susceptible fungal infections: IV: Adults: 0.3 to 1.5 mg/kg/day; 1 to 1.5 mg/kg over 4 to 6
hours every other day may be given once therapy is established; aspergillosis,
rhinocerebral mucormycosis, often require 1 to 1.5 mg/kg/day; do not exceed 1.5
mg/kg/day

Aspergillosis, disseminated: IV: 0.6 to 0.7 mg/kg/day for 3 to 6 months. Note: IDSA
recommends amphotericin B (conventional) be reserved for use in resource limited
settings when no alternatives are available; voriconazole is preferred therapy for
invasive Aspergillus infections (IDSA [Patterson 2016]).

Aspergillosis (ocular) (off-label use): Ophthalmic:

Intraocular: Inject 5 to 10 mcg in a 0.1 mL volume as a single dose intravitreally or

intracamerally to the affected eye; may be repeated in 4 to 7 days as clinically
indicated (Kaushik 2001; Patterson 2016). Guidelines recommend concomitant
vitrectomy and use in combination with systemic voriconazole (Patterson 2016).

Topical (0.1% to 0.2% solution): Apply to affected eye every 30 to 60 minutes until
symptoms resolve (may take weeks) (Kaushik 2001; Ritterband 2002; Tamcelik
2002). Note: Ophthalmic natamycin is the preferred treatment (Patterson 2016)

Blastomycosis: Moderately severe to severe pulmonary disease, disseminated

extrapulmonary disease or immunosuppressed patients: IV: 0.7 to 1 mg/kg/day for 1 to
2 weeks or until improvement is noted, followed by oral itraconazole for 6 to 12 months
(IDSA [Chapman 2008])

Candidiasis:

CNS infection (failed to respond to systemic therapy and device removal or when
ventricular device cannot be removed) (off-label): Intraventricular: 0.01 to 0.5 mg/2
mL of an extemporaneously prepared solution in D5W administered through the
device into the ventricle (IDSA [Pappas 2016]; IDSA [Tunkel 2017])

Endophthalmitis due to Candida (off-label use): Patients with vitritis or with

macular involvement (with or without vitritis): Intravitreal: 5 to 10 mcg/0.1 mL of an
extemporaneously prepared solution in sterile water; administer with concomitant
systemic antifungal therapy (IDSA [Pappas 2016])

Esophageal (alternative therapy) (off-label use): IV: 0.3 to 0.7 mg/kg/day. Consider
step down to an oral antifungal once patient is able to tolerate oral intake. In
fluconazole-refractory disease, continue amphotericin B (conventional) for 21 days
(IDSA [Pappas 2016]). Note: For patients with HIV, the recommended dose is 0.6
mg/kg/day for 14 to 21 days (HHS [OI adult 2020]).

Invasive candidiasis (alternative therapy): IV: 0.5 to 0.7 mg/kg/day; dose may be
increased to as high as 1 mg/kg/day for infections caused by C. glabrata or C.
krusei. Note: Given poor tolerability (eg, nephrotoxicity, infusion-related toxicity),
experts preferentially recommend lipid formulations when available (IDSA [Pappas
2016]).

Oropharyngeal (fluconazole-refractory): Non-HIV-infected patients (alternative

therapy) (off-label use): Oral: 100 mg of an extemporaneously compounded 100
mg/mL suspension 4 times daily (IDSA [Pappas 2016])

Urinary tract candidiasis (off-label use) (IDSA [Pappas 2016]):

Asymptomatic candiduria in patients undergoing urologic procedures: IV: 0.3 to

0.6 mg/kg daily for several days before and after the procedure

Fungus balls: Irrigation via nephrostomy tubes (off-label route): Irrigate with an
extemporaneously prepared solution of 25 to 50 mg in 200 to 500 mL sterile
water (final concentration range: 0.05 to 0.25 mg/mL)

Pyelonephritis: C. krusei or fluconazole-resistant C. glabrata: IV: 0.3 to 0.6

mg/kg/day for 1 to 7 days (with or without flucytosine for fluconazole-resistant
C. glabrata)

Symptomatic cystitis:

C. krusei or fluconazole-resistant C. glabrata: IV: 0.3 to 0.6 mg/kg/day for 1

to 7 days
 Fluconazole-resistant species (eg. C. krusei, C. glabrata) Bladder irrigation
(off-label route): Irrigate with a 0.05 mg/mL (50 mg/L) sterile water
solution instilled for 5 to 7 days or until cultures are clear. Note:
Recommended for use in conjunction with other treatment modalities
(Fisher 2011).

Coccidioidomycosis in patients with HIV with severe, non-meningeal infection (ie,

diffuse pulmonary or severely ill with extrathoracic disseminated disease): IV: 0.7
to 1 mg/kg/day until clinical improvement, then initiate triazole therapy (eg,
fluconazole or itraconazole) (HHS [OI adult 2020]).

Cryptococcal disease (meningitis, disseminated, or severe pulmonary disease), in

patients with HIV: IV: Induction: 0.7 to 1 mg/kg/day (with flucytosine [preferred] or
fluconazole or without a concomitant agent) for 2 weeks, then change to oral
fluconazole for consolidation/maintenance therapy (HHS [OI adult] 2020).

Histoplasmosis: Moderately severe to severe pulmonary or disseminated disease (off-

label): IV: 0.7 to 1 mg/kg/day for 1 to 2 weeks, followed by oral itraconazole for 12
weeks (pulmonary disease) or 12 months (disseminated disease) (IDSA [Wheat 2007])

Leishmaniasis (alternative agent):

Cutaneous: IV: 0.5 to 1 mg/kg/dose once daily or every other day for a total
cumulative dose of ~15 to 30 mg/kg (IDSA/ASTMH [Aronson 2016])

Mucosal: IV: 0.5 to 1 mg/kg/dose once daily or every other day for a total
cumulative dose of ~20 to 45 mg/kg (IDSA/ASTMH [Aronson 2016]).

Visceral (off label): IV: 1 mg/kg/dose once daily or every other day for a total
cumulative dose of 15 to 20 mg/kg (IDSA/ASTMH [Aronson 2016]).

Visceral, patients with HIV (off label): IV: 0.5 to 1 mg/kg/dose once daily for a total
cumulative dose of 1,500 to 2,000 mg (HHS [OI adult 2020]).

Sporotrichosis: Pulmonary, meningeal, osteoarticular, or disseminated: IV: 0.7 to 1

mg/kg/day; after the patient has shown a favorable response, can change to oral
itraconazole for suppressive therapy for a total duration of therapy of ≥12 months
(IDSA [Kauffman 2007).

Talaromycosis (formerly penicilliosis) (alternative agent) (off-label use): IV: 0.7

mg/kg/day for 2 weeks (if liposomal amphotericin B unavailable) followed by oral azole
consolidation therapy (HHS [OI adult 2020]).