Amphotericin B lipid complex

Amphotericin B-induced ARF occurs in as many as 40% to 65% of patients treated with the conventional desoxycholate formulation.30 Nephrotoxicity is due to renal arterial vasoconstriction and distal renal tubule cell damage. Risk factors include high doses, treatment for at least 7 days, preexisting kidney dysfunction, and concomitant use of other nephrotoxic drugs.31 Three lipid-based formulations of amphotericin B have been developed in an attempt to decrease the incidence of ARF amphotericin B lipid complex, amphotericin colloidal dispersion, and liposomal amphotericin B. The range of... 

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

Lipid-associated formulations of amphotericin B, liposomal amphotericin B (AmBisome) and amphotericin B lipid complex (Abelcet) have been approved for use in proven cases of candidiasis however, patients with invasive candidiasis have also been treated successfully with amphotericin B colloid dispersion (Amphotec or Amphocil). The lipid-associated formulations are less toxic but as effective as amphotericin B deoxycholate. 

Candida albicans, C. tropicalis, C parapsilosis and resolution of signs and symptoms of infection Remove existing central venous catheters when feasible, plus Amphotericin B IV 0.6 mg/k day or Fluconazole IV/po 6 mg/kg/day or An echinocandin or Amphotericin B IV 0.7 mg/kg/day plus fluconazole IV/po 800 mg/day Patients intolerant or refractory to other therapf Amphotericin B lipid complex IV 5 m k day Liposomal amphotericin B IV 3-5 mg/kg/day Amphotericin B colloid dispersion IV 2-6 mg/k day (continued)... 

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. 

Amphotericin B (Amphocin) Amphotericin B Cholesteryl (Amphotec) Amphotericin B Lipid Complex (Abelcet) Amphotericin B Liposomal (AmBisome) Anidulafungin (Eraxis)... 

Suspension for Injection-. 5 mg/ml (Amphotericin B lipid complex, Abelcet). 

Adedoyin, A., C.E. Swenson, L.E. Bolcsak, A. Hellmann, D. Radowska, G. Horwith, A.S. Janoff, and R.A. Branch, A pharmacokinetic study of amphotericin B lipid complex injection (Abelcet) in patients with definite or probable systemic fungal infections. Antimicrob Agents Chemother, 2000.44(10) 2900-2. 

FIGURE 14.9 Freeze-fracture electron micrograph of the ribbon-like amphotericin B lipid complexes. (From Bangham (1992). With permission.)... 

Normally, reconstituted amphotericin B solutions are administered by slow infusion over a period of six hours (minimum one to two hours) to avoid potentially serious adverse effects. The manufacturers state that during administration the IV infusion solutions should be "protected from light." Photoprotection during administration is not required for ampothericin B cholesteryl sulfate complex, amphotericin B lipid complex, or liposomal formulations of amphotericin B. The administration of amphotericin B in parenteral fat emulsions is no longer an accepted practice. 

Having a broad-spectrum fungicidal activity, amphotericin remains the mainstay of treatment of most invasive fungal infections. Compared with conventional amphotericin B deoxycholate, other lipid formulations of amphotericin (amphotericin B colloidal dispersion, amphotericin B lipid complex, and liposomal amphotericin B) facilitate treatment in patients with suspected and proven invasive mycoses, who are intolerant of or refractory to conventional amphotericin. 

Adedoyin A, Bernardo JF, Swenson CE, Bolsack LE, Horwith G, DeWit S, Kelly E, Klasterksy J, ScuUer JP, DeValeriola D, Anaissie E, Lopez-Berestein G, Llanos-Cuentas A, Boyle A, Branch RA. Pharmacokinetic profile of ABELCET (amphotericin B lipid complex injection) combined experience from phase I and phase II studies. Antimicrob Agents Chemother 1997 41(10) 2201-8. 

Allsup D, Chu P. The use of amphotericin B lipid complex in 15 patients with presumed or proven fungal infection. Br J Haematol 1998 102(4) 1109-10. 

Myint H, Kyi AA, Winn RM. An open, non-comparative evaluation of the efficacy and safety of amphotericin B lipid complex as treatment of neutropenic patients with presumed or confirmed pulmonary fungal infections. J Antimicrob Chemother 1998 41(3) 424-6. 

Ringden O, Jonsson V, Hansen M, ToUemar J, Jacobsen N. Severe and common side-effects of amphotericin B lipid complex (Abelcet). Bone Marrow Transplant 1998 22(7) 733. ... 

Linden P, Lee L, Walsh TJ. Retrospective analysis of the dosage of amphotericin B lipid complex for the treatment of invasive fungal infections. Pharmacotherapy 1999 19(ll) 1261-8. 

Singhal S, Hastings JG, Mutimer DJ. Safety of high-dose amphotericin B lipid complex. Bone Marrow Transplant 1999 24(1) 116-17. 

Martino R, Subira M, Sureda A, Sierra J. Amphotericin B lipid complex at 3 mg/kg/day for treatment of invasive fungal infections in adults with haematological malignancies. J Antimicrob Chemother 1999 44(4) 569-72. 

Subira M, Martino R, Sureda A, Altes A, Briones J, Brunet S, Sierra J. Safety and efficacy of low-dose amphotericin B lipid complex for empirical antifungal therapy of neutropenic fever in patients with hematologic malignancies. Methods Find Exp Chn Pharmacol 2001 23(9) 505-10. 

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. 

Slain D, Miller K, Khakoo R, Fisher M, Wierman T, Jozefczyk K. Infreqnent occurrence of amphotericin B lipid complex-associated nephrotoxicity in various clinical settings at a university hospital a retrospective stndy. Qin Ther 2002 24(10) 1636-42. 

Amphotericin B lipid complex for neonatal invasive candidiasis. Arch Dis Child Fetal Neonatal Ed 2001 84(2) F131-3. 

Walsh TJ, Seibel NL, Arndt C, et al. Amphotericin B lipid complex in pediatric patients with invasive fungal infections. Pediatr Infect DisJ 1999 18 702-8. 

Sharkey PK, Graybill JR, Johnson ES, et al. Amphotericin B lipid complex compared with amphotericin B in the treatment of cryptococcal meningitis in patients with AIDS. Clin Infect Dis 1996 22 315-21. 

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