Renal impairment amphotericin

Flucytosine is contraindicated in patients with known hypersensitivity to the drug. Flucytosine is used cautiously in patients with bone marrow depression and with extreme caution in those with renal impairment. The drug is also used cautiously during pregnancy (Category C) and lactation. When flucytosine and amphotericin B are administered concurrently, the risk of flucytosine toxicity is increased. 

Lipid-based formuiations - For use in patients refractory to conventional amphotericin B deoxycholate therapy or where renal impairment or unacceptable toxicity precludes the use of the deoxycholate formulation for the treatment of invasive fungal infections (lipid complex) for the treatment of invasive aspergillosis (cholesteryl) for the treatment of infections caused by... 

Rhinocerebral p/iycomycos/s A cumulative dose of at least 3 g amphotericin B is recommended. Although a total dose of 3 to 4 g will infrequently cause lasting renal impairment, it is a reasonable minimum where there is clinical evidence of deep tissue invasion. Rhinocerebral phycomycosis usually follows a rapidly fatal course therapy must be more aggressive than that for more indolent mycoses. 

Lipid formulations of amphotericin B have been shown to reduce the severe kidney toxicity of amphotericin B and are indicated in patients with renal impairment or when unacceptable toxicity precludes the use of amphotericin B deoxycholate in effective doses. 

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,... 

Flucytosine (Ancobon) possesses clinically useful activity against Cryptococcus neoformans, Candida species, Torulopsis glabrata, and the agents of chromomycosis. Susceptible fungi deam-inate flucytosine to 5-fluorouracil, which becomes an antimetabolite. Flucytosine, which is excreted by the kidney, should be used cautiously in the setting of renal impairment. Flucytosine is a bone marrow depressant. Flucytosine is used in combination with amphotericin B. 

Renal damage is the most significant toxic reaction. Renal impairment occurs in nearly all patients treated with clinically significant doses of amphotericin. The degree of azotemia is variable and often stabilizes during therapy, but can be serious enough to necessitate dialysis. A reversible component is associated with decreased renal perfusion and represents a form of prerenal renal failure. An irreversible component results from renal tubular injury and subsequent dysfunction. 

The Collaborative Exchange of Antifungal Research (CLEAR) retrospectively reviewed the efficacy and renal safety in patients with Candida infections treated with hpid-complex amphotericin B (ABLC) and showed comparable response rates compared with conventional amphotericin B and evidence that ABLC may be used safely to treat patients at increased risk for renal impairment (Alexander and Wingard). 

Anaissie EJ, Mattiuzzi GN, Miller CB, Noskin GA, Gurwith MJ, Mamelok RD, Pietrelli LA. Treatment of invasive fungal infections in renally impaired patients with amphotericin B colloidal dispersion. Antimicrob Agents Chemother 1998 42(3) 606-11. 

Branch RA. Prevention of amphotericin B-indnced renal impairment. A review on the use of sodium supplementation. Arch Intern Med 1988 148(ll) 2389-94. 

Amphotec P is indicated in the treatment of invasive aspergillosis when renal impairment or nnacceptable toxicity precludes nse of amphotericin B deoxycholate and where prior amphotericin B deoxycholate therapy has failed. 

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