Section 15 · Monograph
Liposomal amphotericin B
Reviewed Nov 2026FDA label
AmBisomePolyene antifungal
- Forms
- IV: 50mg vial
- Dose
- Cryptococcal meningitis: 3-6mg/kg/day IV, given with flucytosine
- MOA
- Binds ergosterol, forms fungal membrane pores
Indications
- Cryptococcal meningitis in HIV-infected patientsFDA-labeled
- Empirical therapy for presumed fungal infection in febrile neutropenic patientsFDA-labeled
- Systemic Aspergillus, Candida and Cryptococcus infections; visceral leishmaniasisFDA-labeled
Mechanism of Action
- Binds ergosterol in fungal membranes, forming pores that cause leakage and cell death; the liposomal formulation reduces nephrotoxicity versus conventional amphotericin B
Full Dosing
Adult / usual
- Label dose for cryptococcal meningitis in HIV: 6mg/kg IV once daily
- Guidelines commonly use 3-4mg/kg/day with flucytosine (100mg/kg/day) for at least 2 weeks of induction
- Infuse over about 120 minutes (30-60 if tolerated); pre-hydrate and replace potassium and magnesium
Contraindications
- Hypersensitivity to amphotericin B or components, unless benefit outweighs risk
Drug Interactions
- Nephrotoxic drugs (cyclosporine, aminoglycosides) are additive
- Corticosteroids worsen hypokalemia
- Hypokalemia increases digoxin toxicity
Adverse Effects
- Infusion reactions (fever, chills, hypoxia, back/chest pain)
- Hypokalemia and hypomagnesemia
- Nephrotoxicity
- Liver enzyme elevation
Monitoring Parameters
- Renal function, potassium, magnesium, CBC and liver tests
- Infusion reactions
Pregnancy & Lactation
- Limited data; use if benefit outweighs risk
- Unknown whether present in human milk