Corticosteroids Amphotericin

AMPHOTERICIN CORTICOSTEROIDS Risk of hyperkalaemia Additive effect Avoid co-administration... 

Drugs that may be affected by itraconazole include alfentanil, almotriptan, alprazolam, amphotericin B, aripiprazole, benzodiazepines, buspirone, busulfan, calcium blockers, carbamazepine, cilostazol, cisapride, corticosteroids, cyclosporine, digoxin, disopyramide, docetaxel, dofetilide, eletriptan, epierenone, ergot alkaloids, haloperidol, HMG-CoA reductase inhibitors, hydantoins (phenytoin), hypoglycemic agents, oral midazolam, phosphodiesterase type 5 inhibitors, pimozide, polyenes, protease inhibitors, quinidine, rifamycins, sirolimus, tacrolimus, tolterodine, triazolam, trimetrexate, vinca alkaloids, warfarin, and zolpidem. 

T Effects W/ antihypertensives, cliazoxicle, nitrates, EtOH T effects OF ACEIs, Li T risk of hypokalemia W/ amphotericin B, corticosteroids, mezlocillin, piperacillin, ticarcillin effects W/ cholestyramine, colestipol, NSAIDs EMS Monitor ECG for hypokalemia (flattened T waves) T risk of photosensitivity Rxns use caution w/ other diuretics, may T risk of electrolyte imbalances and dehydration may affect glucose (hyperglycemia) OD May cause dehydration, hypotension, drowsiness, headache, and fatigue symptomatic and supportive, do not do anything that would force greater fluid loss (ie, induce V)... 

Self-limited disease Amphotericin 6 0.3-0.5 mg/kg/day x 2-4 weeks (total dose 500 or ketoconazole 400 mg orally daily x 3-6 months can be beneficial in patients with severe hypoxia following inhalation of large inocula Antifungal therapy generally not useful for arthritis or pericarditis NSAIDs or corticosteroids can be useful in some cases Most lesions resolve spontaneously surgery or antifungal therapy with amphotericin B 40-50 mg/dayx2-3 weeks or itraconazole 400 m day orally x 6-12 months can be beneficial in some severe cases mild to moderate disease can be treated wHh itraconazole for 6-12 months Amphotericin B 0.7 mg/k day, for a total dose of SSm kg (or 3 rng/k day of one of the lipid preparations) prednisone 60 mg daily tapered over 2 weeks/ followed by itraconazole 200 rng twice daily for 6-12 weeks in patients who do not require hospitalization, itraconazole 200 mg once or twice daily for 6-12 weeks can be used... 

Clinically important, potentially hazardous interactions with amiloride, aminoglycosides, amphotericin B, ampicillin, anisindione, anticoagulants, armodafinil, atorvastatin, azathioprine, azithromycin, bacampicillin, basiliximab, bezafibrate, bosentan, bupropion, carbenicillin, caspofungin, cholestyramine, clarithromycin, cloxacillin, co-trimoxazole, corticosteroids, cyclophosphamide, daclizumab, danazol, dicloxacillin, dicumarol, digoxin, diltiazem, disulfiram, echinacea, erythromycin, ethotoin, etoposide, ezetimibe, flunisolide, fluoxymesterone, fluvastatin, foscarnet, fosphenytoin, gemfibrozil, hemophilus B vaccine, HMG-CoA reductase inhibitors, imatinib, imipenem/cilastatin, influenza vaccines, ketoconazole, lanreotide, lopinavir, lovastatin, mephenytoin, methicillin, methoxsalen, methylphenidate, methylprednisolone, methyltestosterone, mezlocillin, mizolastine, mycophenolate, nafcillin, nisoldipine, NSAIDs, orlistat, oxacillin, penicillins, phellodendron, phenytoin, pravastatin, prednisolone, prednisone, pristinamycin, ranolazine, red rice yeast, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, simvastatin, sirolimus, spironolactone, St John s wort, sulfacetamide, sulfadiazine, sulfamethoxazole, sulfisoxazole, sulfonamides, tacrolimus, telithromycin, tenoxicam, testosterone, ticarcillin, tolvaptan, trabectedin, triamterene, troleandomycin, ursodeoxycholic acid, vaccines, vecuronium, warfarin, zofenopril... 

Clinically important, potentially hazardous interactions with ACTH, amphotericin, carbenoxolone, corticosteroids, laxatives, lithium... 

Self-limited disease 1-50 Self-limited d/sease Amphotericin 0.3-0.5 mg/k day x 2 weeks (total dose 500 mg) or ketoconazole 400 mg orally daily x 3-6 months may be beneficial in patients with severe hypoxia following inhalation of large inocula Antifungal therapy generally not useful for arthritis or pericarditis NSAIDs or corticosteroids may be useful in some cases... 

Many clinicians advocate early institution of empirical TV amphotericin B in patients with neutropenia and persistent (>5-7 days) fever. However, the potential toxicities (particularly nephrotoxicity) of this agent preclude its routine use in all patients. Suggested criteria for the empirical use of amphotericin B include (1) fever of 5 to 7 days duration that is umesponsive to antibacterial agents, (2) neutropenia of more than 7 days duration, (3) no other obvious cause for fever, (4) progressive debilitation, (5) chronic adrenal corticosteroid therapy, and (6) indwelling intravascular catheters. In patients who fail therapy with amphotericin B, hpid formulations of amphotericin B may be used (3-5 mg/kg per day). 

Thiazide diuretics may diminish the effects of anticoagulants, uricosuric agents used to treat gout, sulfonylureas, and insulin and increase the effects of anesthetics, diazoxide, cardiac glycosides, hthium, loop diuretics, and vitamin D. The effectiveness of thiazide diuretics may be reduced by NSAlDs and bile acid sequestrants (reduced absorption of thiazides). Amphotericin B and corticosteroids increase the risk of hypokalemia induced by thiazide diuretics. 

Increased risk of toxicity with drugs that alter serum electrolytes (potassium -depleting diuretics, corticosteroids, thiazide and loop diuretics, amphotericin B, quinidine, amiodarone). Blockers of p adrenergic receptors, calcium channels, or acetylcholinesterase increase risk of complete AV block. Drugs which alter Gl absorption may alter bioavallabillty. 

The combined use of drugs that can cause hypokalaemia (e.g. amphotericin B, corticosteroids, thiazide and ioop diuretics, and stimuiant iaxatives) and drugs that proiong the QT intervai (e.g. ciass la and ciass in antiarrhythmics see Tabie 9.2 , (above)) shouid be well monitored because hypokalaemia increases the risk of torsade de pointes arrhythmias. There appear to be only a few reports of this interaction, for example, see Beta blockers + Potassium-depleting drugs , p.8S2. ... 

The use of potassium-depleting diuretics can precipitate the development of potentially life-threatening torsade de pointes arrhythmias in patients taking sotalol unless potassium levels are maintained. This would also be expected with other potassium-depleting drugs such as corticosteroids, some laxatives, and intravenous amphotericin. Chlortalidone and hydrochlorothiazide may reduce the bioavailability of celiprolol, but the evidence for this is sparse. 

A number of drugs, including amphotericin B, carbenoxolone, and corticosteroids, cause potassium loss, which could lead to the development of digitalis toxicity. 

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