Amphotericin B lipid complex ABLC

Janoff AS, et al. Amphotericin B lipid complex (ABLC ) a molecular rationale for the attenuation of AmB related toxicities. J Liposome Res 1993 3 451. 

Fleming RV, Kantarjian HM, Husni R, Rolston K, Lim J, Raad I, Pierce S, Cortes J, Estey E. Comparison of amphotericin B lipid complex (ABLC) vs. ambisome in the treatment of suspected or documented fungal infections in patients with leukemia. Leuk Lymphoma 2001 40(5-6) 511-20. 

Rowles DM, Fraser SL. Amphotericin B lipid complex (ABLC)-associated hypertension case report and review. Clin Infect Dis 1999 29(6) 1564-5. 

In patients intolerant to amphotericin B or fluconazole, one of the lipid formulations may he used. In a randomized trial, amphotericin B lipid complex (ABLC) was found to he equivalent to 0.6-1 mg/kg per day of amphotericin B, and open-lahel therapy with amphotericin B colloid dispersion (ABCD) has been successful. 

The use of deoxycholate amphotericin B frequently is associated with the development of induced nephrotoxicity. In an attempt to decrease the incidence of nephrotoxicity, three lipid formulations of amphotericin B have been developed and approved for use in humans amphotericin B lipid complex (ABLC, Abelcet Enzon Pharmaceuticals), amphotericin B colloidal dispersion (ABCD, Amphotec Inter-mune Pharmaceuticals), and liposomal amphotericin B (AmBisome Gilead Pharmaceuticals). In these preparations, amphotericin B is incorporated into the phospholipid bilayer membrane rather than in the enclosed aqueous phase. 

Despite early enthusiasm, more recent studies have yielded more equivocal information. In a randomized, double blind study, Wingard et al [146] have compared the safety of two Upid formulations of amphotericin B in febrile neutropenic patients. Subjects were randomized to receive amphotericin B lipid complex (ABLC) at a dose of 5 mg/kg/d (n=78), liposomal amphotericin B (L-Amph) at a dose of 3 mg/kg/ d (n=85), or L-Amph at a dose of 5 mg/kg/d (n=81). They found that the incidence of nephrotoxicity (doubhng of the base-... 

Amphotericin B is complexed with deoxycholate (C-AMB) and marketed as a lyophilized powder (fungizone) containing 50 mg of amphotericin B that forms a colloid in water. Three lipid formulations of amphotericin B are marketed in the U.S. Amphotericin B colloidal dispersion (ABCD, AMPHOTEC, amphocil) contains equimolar amounts of amphotericin B and cholesteryl sulfate. AMBISOME is a small, unilamellar vesicle formulation that combines amphotericin B (50 mg) with 350 mg of lipid (phosphatidylcholine, cholesterol, and distearoylphosphatidylglycerol, in molar ratio of 10 5 4) in an -10% molar ratio. Amphotericin B lipid complex (ABLC, abelcet) contains dimyristoylphosphatidylcholine and dimyristoylphosphatidylglycerol in a 7 3 mixture with -35 mol% of amphotericin B. 

In a systematic review of the risk of nephrotojddty induced by two different lipid formulations of amphotericin, amphotericin B lipid complex (ABLC) and liposomal amphotericin B (l-AtuB), 11 studies were identified and 8 were included [5 ]. There was a higher probability of nephrotoxicity in patients who received ABLC versus L-AmB (OR=1.75 RR = 1.55), but there was a significant lack of homogeneity across these studies. Restricted analyses, omitting different studies that contributed to the heterogeneity, showed that the risks were more similar between the two formulations. 

Management of adverse reactions Administration of amphotericin B lipid complex (ABLC) may be associated with infusion-related reactions, such as fever, rigors, and chills. Premedication with hydrocortisone may reduce the incidence of these reactions, but there are currently limited confirmatory data from clinical practice [7 ]. In a prospective 18-month study, patients with cancers were given intravenous hydrocortisone 100 mg 15-30 minutes before each infusion of ABLC (275 cycles mean dose per cycle 931 mg) [14. There were 44 infusion-related reactions (16%), most of which followed the first infusion of a cycle (15% subsequent infusions 2.9%). The most common reactions were rigors (15%) and fever (13). There was no significant difference in the rates or types of reactions between ABLC-naive and previously treated patients. The dose of ABLC had no effect on the rate of reactions, but female sex, neutropenia, and being younger were predictive. 

ABLC = Amphotericin B Lipid Complex ABCD = Amphotericin B Colloidal Dispersion L-AMB = Liposomal Amphotericin B... 

Wingard J, White M, Anaissie E, et al. A randomized, double-blind comparative trial evaluating the safety of liposomal amphotericin B versus amphotericin B lipid complex in the empirical treatment of febrile neutropenia. L Amph/ABLC Comparative Study Group. Clin Infect Dis 2000 31 1155-1163. 

Husain S, Capitano B, Corcoran T, Studer SM, Crespo M, Johnson B, Pilewski JM, Shutt K, Pakstis DL, Zhang S, Carey ME, Paterson DL, McCurry KR, Venkataramanan R. Intrapulmonary disposition of amphotericin B after aerosolized delivery of amphotericin B lipid complex (Abelcet ABLC) in lung transplant recipients. Transplantation 2010 90(11) 1215-9. 

ABLC amphotericin B in lipid complex ATN acute tubular necrosis... 

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