Chills amphotericin

AMPHOTERICIN B. Fever (sometimes with shaking chills) may occur within 15 to 20 minutes of initiation of the treatment regimen. It is important to monitor the patient s temperature, pulse, respirations, and blood pressure carefully during the first 30 minutes to 1 hour of treatment. The nurse should monitor vital signs every 2 to 4 hours during therapy, depending on the patient s condition. 

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. 

Amphotericin B Cholesteryl (Amphotec) [Antifungal/Polyene Mocrollde] Uses AspCTgillosis if intolCTant/refractory to conventional amphotericin B, systemic candidiasis Action Binds ceU membrane sterols, alters permeability Dose Adults Peds. Test dose 1.6—8.3 mg, over 15-20 min, then 3-4 mg/kg/d 1 mg/kg/h inf w/ renal insuff Caution [B, ] Disp Inj SE Anaphylaxis fever, chills, HA, nephrotox, -1- BP, anemia Notes Do not use in-line filter Interactions See Amphotericin B EMS See AmphotCTicin B OD May cause cardiac arrest s ptomatic and supportive... 

Amphotericin-B is highly toxic as ergosterol is very similar to cholesterol and amphotericin has thus cross-reactivity to cholesterol in human cell membranes. Adverse effects include chills, fever, dyspnea, hepatotoxicity and anemia. However, nephrotoxicity is the most common complication, although adequate hydration can reduce the risk for this toxicity to some extend. Amphotericin induced nephrotoxicity may be irreversible. Liposomal preparations have shown to be therapeutically effective with little or no renal damage. 

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. 

WARNING Renal impair is the major tox follow administration instructions Uses CMV retinitis w/ HIV Action Selective inhibition of viral DNA synth Dose Rx 5 mg/kg IV over 1 h once/wk for 2 wk w/ probenecid Maint 5 mg/kg IV once/2 wk w/ probenecid (2 g PO 3 h prior to cidofovir, then 1 g PO at 2 h 8 h after cidofovir) 1 in renal impair Caution [C, -] Contra Probenecid or sulfa allergy Disp Inj SE Renal tox, chills, fever, HA, N/V/D, thrombocytopenia, neutropenia Interactions T Nephrotox W/ aminoglycosides, amphotericin B, foscar-net, IV pentamidine, NSAEDs, vancomycin T effects W/ zidovudine EMS Monitor ECG for hypocalcemia (T QT interval) and hypokalemia (flattened T waves) OD May cause renal failure hydration may be effective in reducing drug levels/effects Cilostazol (Pletal) [Antiplatelet, Arterial Vasodilator/ Phosphodiesterase Inhibitor] Uses Reduce Sxs of intermittent claudication Action Phosphodiesterase m inhibitor T s cAMP in pits blood vessels, vasodilation inhibit pit aggregation Dose 100 mg PO bid, 1/2 h before or 2 h after breakfast dinner Caution [C, +/-] Contra CHF, hemostatic disorders,... 

Amphotericin is highly effective in the treatment of visceral leishmaniasis (18). In a prospective study of 938 patients from Bihar, India, who received the drug in a dosage of 1 mg/kg/day infused over 2 hours for 20 days, serum creatinine values over 177 pmol/l were noted in 6.3%, and acute renal insufficiency developed in three patients. Two patients died, possibly related to amphotericin, one with renal insufficiency and one with hypokalemia and cardiac arrest. Infnsion-related chills occurred in 92% and fever in 40% of patients. The parasitological cure rate (no relapse within 6 months) exceeded 99%. 

The safety and efficacy of amphotericin colloidal dispersion have been evaluated in 148 immunocompromised patients with candidemia (20). ABCD was given intravenously in a median daily dose of 3.9 (range 0.1-9.1) mg/kg for a median of 12 (range 1-72) days. In the safety analysis (n = 148 patients), nephrotoxicity occurred in 16% of the patients, with either doubling of the baseline serum creatinine concentration or an increase of 88 pmol/l (1.0 mg/dl) or a 50% fall in calculated creatinine clearance. Severe adverse events were believed to be probably or possibly related to ABCD in 36 patients (24%), including chills and fever (9.5%), hypotension and abnormal kidney function (4%), tachycardia, asthma, hypotension (3%), and dyspnea (2%). ABCD was withdrawn in 12%... 

In an open, sequential phase II clinical study of three different regimens of liposomal amphotericin for visceral leishmaniasis (2 mg/kg on days 1-6 and on day 10 2 mg/ kg on days 1-4 and on day 10 2 mg/kg on days 1, 5, and 10) in Indian and Kenyan patients in three developing countries, there were few infusion-associated adverse effects (40). Of 32 Brazilian patients (15 of whom received 2 mg/kg on days 1-10 because of poor responses to the first regimen, 37% had a fever with one or more infusions, 9% had chills, and 6% had back pain in addition, three patients had respiratory distress and/or cardiac dysrhythmias. There were different response rates to the three regimens in the different countries, leading to the recommendation of 2 mg/kg on days 1-4 and day 10 in India and Kenya, and 2 mg/kg on days 1-10 in Brazil. 

Amphotericin colloidal dispersion has been compared with amphotericin deoxycholate in a prospective, randomized, double-blind study in the empirical treatment of fever and neutropenia in 213 patients (25). Patients were stratified by age and concomitant use of ciclosporin or tacrolimus and then randomized to receive ABCD (4 mg/kg/day) or amphotericin deoxycholate (0.8 mg/ kg/day) for 14 days. Renal dysfunction was less likely to develop and occurred later with ABCD than with amphotericin deoxycholate. Likewise, the absolute and percentage fall in the serum potassium concentration from baseline to the end of therapy was greater with amphotericin deoxycholate than ABCD. However, probable or possible infusion-related hypoxia and chills were more common with ABCD than amphotericin deoxycholate. There was a therapeutic response in 50% of the patients who received ABCD and 43% of those who received amphotericin deoxycholate. Thus, ABCD was of comparable efficacy and less nephrotoxic than amphotericin deoxycholate, but infusion-related events were more common with ABCD. 

Intravenous administration of DAMB has been associated with pulmonary reactions, including dyspnea, bronchospasm, fever, and chills in contrast to rare reports of dyspnea after liposomal amphotericin (5), dyspnea was not associated with general toxic reactions. The possibility that liposome overload is the explanation of this reaction should be considered. 

A further multicenter, randomized study comparing amphotericin B lipid complex with conventional amphotericin B (AmB) as empiric therapy for febrile neutropenic patients, found a similar incidence of nephrotoxicity (defined as a doubling of the baseline serum creatinine concentration) and infusion-related reactions (fever and chills) in both treatment arms [147]. 

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