Hydrocortisone Amphotericin

The combined pharmaceutical appHcations account for an estimated 25% of DMF consumption. In the pharmaceutical industry, DMF is used in many processes as a reaction and crystallizing solvent because of its remarkable solvent properties. For example, hydrocortisone acetate [50-03-3] dihydrostreptomycin sulfate [5490-27-7] and amphotericin A [1405-32-9] are pharmaceutical products whose crystallization is faciHtated by the use of DMF. Itis also a good solvent for the fungicide griseofulvin/72%(97-< 7 and is used in its production. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Incompatibilities Do not mix IV minocycline before or during administration with any solutions containing the following Adrenocorticotropic hormone (ACTH), aminophylline, amobarbital sodium, amphotericin B, bicarbonate infusion mixtures, calcium gluconate or chloride, carbenicillin, cephalothin sodium, cefazolin sodium, chloramphenicol succinate, colistin sulfate, heparin sodium, hydrocortisone sodium succinate, iodine sodium, methicillin sodium, novobiocin, penicillin, pentobarbital, phenytoin sodium, polymyxin, prochlorperazine, sodium ascorbate, sulfadiazine, sulfisoxazole, thiopental sodium, vitamin K (sodium bisulfate or sodium salt), whole blood. 

Fever, chills, and tachypnea commonly occur shortly after the initial intravenous doses of amphotericin B this is not generally an allergic hypersensitivity to the drug, which is extremely rare. Continued administration of amphotericin B is accomplished by premedication with acetaminophen, aspirin, and/or diphenhydramine or the addition of hydrocortisone to the infusion bag. 

During the infusion of amphotericin B, the patient s temperature will rise, which may or may not be accompanied by hypotension and delirium. Often, hydrocortisone sodium succinate is added to the infusion during the initial but not the succeeding alternate-day treatment with amphotericin B. 

Aspirin, paracetamol, and hydrocortisone are used to control febrile reactions of amphotericin. Patients with a history of adverse effects with amphotericin should be prophylactically treated with antipyretics and hydrocortisone. Antiemetics and pethidine also are used for the treatment of adverse effects of amphotericin. With sodium supplements and hydration therapy, damage to the kidney can be reduced. If conventional amphotericin is not well tolerated by the patient, colloidal carriers can be used as alternative options. Administration of amphotericin with a nephrotoxic drug, such as cyclosporin, may further increase toxicity. Diuretics and anticancer drugs should be avoided with amphotericin. 

Although sedative antihistamines do not potentiate the effect of alcohol, they should be avoided in excess quantity. Overdose of astemizole can be treated with gastric lavage and supportive measures.86 Coadministration of astemizole and ter-fenadine with antiarrhythmics, antipsychotics, cisapride, and diuretics should be avoided. Chlorpheniramine maleate has been found to be incompatible with phe-nobarbitone sodium, kanamycin sulfate, and calcium chloride. Cyclizines have been used alone or with opioids in tablets or in injectable form for euphoric effects. Cyproheptadine has shown dependence in long-term use. Diphenhydramine is reported to be incompatible with amphotericin, cephalothin sodium, and hydrocortisone sodium succinate. Diphenhydramine and pheniramine maleate are sometimes used as drugs of abuse. Studies have shown that promethazine is adsorbed onto glass, plastic containers, and infusion systems.87... 

Prochlorperazine Edisylate Prochlorperazine edisylate is not compatible with sodium chloride solutions containing methyl hydroxybenzoate and propyl hydroxy-benzoate as preservatives, but is compatible with solutions containing benzyl alcohol. Prochlorperazine edisylate salts are incompatible with a number of drugs such as aminophylline, amphotericin, ampicillin sodium, some barbiturates, ben-zylpenicillin salts, calcium gluconate, cefmetazole sodium, cephalothin sodium, chloramphenicol sodium succinate, chlorothiazide sodium, chloramphenicol, morphine sulfate containing phenol, magnesium trisilicate mixture, sodium succinate, chlorothiazide sodium, dimenhydrinate, heparin sodium, hydrocortisone sodium succinate, midazolam hydrochloride, and some sulfonamides.166... 

Endothelial cells are maintained in a basal culture medium, such as DMEM or a proprietary medium supplied with the cells, which is supplemented with hydrocortisone (lug/mL). epidermal growth factor (EGF 100 ug/mL) bovine fibroblast growth factor (FGF 1 ng/mL), antibiotics (gentamicin and amphotericin, at 50 ug/mL) and fetal calf serum (2-10%). Alternatively, bovine brain extract (3 ug/mL) can be used instead of EGF and FGF. The cells are cultured in either standard tissue culture flasks directly on plastic or on flasks coated with collagen. The cells are grown to confluence and subcultured and reseeded in a ratio of 1 3. For all experiments primary endothelial cells should be used between passages 3 and 12. 

Arachnoiditis, manifested by fever and headache, can occur with intrathecal injection of C-AMB it may be decreased by intrathecal administration of 10-15 mg of hydrocortisone. Other serious problems that attend the use of intrathecal injections depend on the injection site. Local injections of amphotericin B into a joint or peritoneal dialysate fluid commonly produce irritation and pain. 

Four patients treated with amphotericin B and hydrocortisone 25 to 40 mg daily developed cardiac enlargement and congestive heart failure. The cardiac size decreased and the heart failure disappeared within 2 weeks of stopping the hydrocortisone. The amphotericin B was continued successfully with the addition of potassium supplements. ... 

Amphotericin B causes potassium to be lost in the urine. Hydrocortisone... 

Chung D-K, Koenig MG. Reversible cardiac enlargement during treatment widi amphotericin B and hydrocortisone. Report of diree cases. Am Rev Respir Dis (1971) 103, 831-41. 

Renal tubular acidosis can occur during amphotericin B therapy [439,440]. Renal tubular acidosis and hykalemia can be easily corrected with oral potassium therapy [436,439,441]. Hydrocortisone and heparin are sometimes used in conjunction with polyene therapy to reduce toxic side effects [442]. The immediate reactions to intravenous amphotericin B therapy (nausea, vomiting and fever) can be controlled to some extent by usually antihistamines and hydrocortisone [443,444] but reports that some of the symptoms of nephrotoxicity may be overcome by mannitol supplementation [445] have been disputed [446]. 

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. 

O Connor N, Borley A. Prospective audit of the effectiveness of hydrocortisone premedication on drug dehvery reactions following amphotericin B lipid complex. Curr Med Res Opin 2009 25 749-54. 

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