Nausea amphotericin

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. 

Normochromic normocytic anemia is the most common hematological side effect of amphotericin B administration thrombocytopenia and leukopenia are much less common. Infusion of the drug into a peripheral vein usually causes phlebitis or thrombophlebitis. Nausea, vomiting, and anorexia are a persistent problem for some patients. 

Adverse effects associated with oral administration of nystatin include mild nausea, diarrhea, and occasional vomiting. Topical application is nonirritating, and allergic contact hypersensitivity is exceedingly uncommon. Topical amphotericin is well tolerated and only occasionally locally irritating. Hypersensitivity is rare. The drug may cause a temporary yellow staining of the skin, especially when the cream vehicle is used. 

Nystatin [nye STAT in] is a polyene antibiotic its structure, chemistry, mode of action, and resistance resemble those of amphotericin B. Its use is restricted to topical treatment of Candida infections because of its systemic toxicity. The drug is negligibly absorbed from the gastrointestinal tract, and it is never used par-enterally. It is administered as an oral agent ( swish and swallow ) for the treatment of oral candidiasis. Excretion in the feces is nearly quantitative. Adverse effects are rare because of its lack of absorption, but occasionally nausea and vomiting occur. 

Amphotericin and itraconazole have been compared in a multicenter, open, randomized study in 277 adults with cancer and neutropenia (54). Itraconazole oral solution (100 mg bd, n — 144) was compared with a combination of amphotericin capsules and nystatin oral suspension n — 133). Adverse events were reported in about 45% of patients in each group. The most frequent were vomiting (14 versus 12 patients), diarrhea (12 versus 9 patients), nausea (5 versus 12 patients), and rash (2 versus 13 patients). There were no differences in liver function... 

Anorexia, nausea, and vomiting are common effects of parenteral administration of amphotericin. Gastrointestinal complaints are markedly less common with liposomal amphotericin than with ABCD(5). 

DM is a 55-year-old man who has been on chronic digoxin therapy for CHF for 3 years. He is currently undergoing treatment with amphotericin B for a fungal pneumonia. Today he complains of dizziness and nausea. Cr 0.8 mg/dl, weight 70 kg. What is the most likely reason for his digoxin toxicity ... 

Amphotericin B 100 mg/mL suspension - RC 1-5 mL swish and swallow 4-5 times Oral Nausea, vomiting, diarrhea with... 

Infusion-related adverse effects of amphotericin B include chills and fevers (the shake and bake syndrome), muscle. spasms, nausea, headache, and hypotension. Antipyretics, antihistamines, and glucocorticoids have all been shown to be helpful. The administration of a 1 mg test dose of amphotericin B is sometimes useful in predicting the severity of infusion-related toxicity. The answer is (D). 

H. pylori is a major etiological factor in gastroduodenal disorders such as chronic gastritis, peptic ulcer, and gastric cancer. Therefore, the treatment and prevention of these diseases would be facilitated by its eradication. At present, triple therapies that comprise two antibiotics (clarithromycin and amphotericin B) and a proton pump inhibitor are used to eradicate H. pylori. However, strains that are resistant to antibiotics have appeared. In addition, antibiotic treatment is associated with serious side effects such as nausea, vomiting, and diarrhea. Therefore, the discovery of novel antibacterial agents that are highly effective and safe is badly needed for the treatment of H. pylori infection. 

Imidazoles arc wide-spectnim antifungal drugs to which resistance rarely develops. Except for ketoconazolc. the imidazoles are poorly absorbed orally. Clotrimazole, econii/ule and miconazole are widely used lopic-aliy in the Ireatment of dennaiophyle and Candida alhicam infections. Miconazole is used intravenously in systemic infections in patients who cannot tolerate amphotericin. It may cause nausea and vomiting, faintness and anaphylaxis. Ketoconazole is well absorbed orally, and has been used in Ihe crealment of local and systemic mycoses. Enthusiasm for ketoconazole has declined because it may cause hepatic necrosis and adrenal suppression. 

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]. 

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