Ambisome

AmBisome is a brand-name formulation of liposomal amphotericin B, an antifungal medication used to treat invasive fungal infections. The drug consists of amphotericin B enclosed in small lipid vesicles (liposomes), which alters its distribution in the body and reduces exposure of the kidneys compared with conventional amphotericin B deoxycholate.

Indications include invasive fungal infections such as aspergillosis, cryptococcal meningitis, histoplasmosis, mucormycosis, and candidiasis, particularly in patients who cannot tolerate conventional amphotericin B or require central nervous system penetration. It is used as initial therapy in some guidelines and as salvage therapy in others.

Administration and dosing: AmBisome is given by intravenous infusion after proper reconstitution and dilution. Typical dosing is 3 to 5 mg per kilogram of body weight per day, with higher doses (up to about 10 mg/kg/day) used for certain infections. The infusion is usually given over 2 to 6 hours. Treatment requires monitoring of kidney function and electrolytes; premedication to lessen infusion-related fever and chills is used variably per protocol.

Adverse effects and safety: Compared with conventional amphotericin B, AmBisome generally has a lower risk of nephrotoxicity and electrolyte disturbances but can still cause kidney impairment, hypokalemia, and hypomagnesemia, as well as fever, chills, and hypotension during infusions. Hepatotoxicity is uncommon. Caution is advised in patients with kidney disease and when combined with other nephrotoxic drugs. It should be avoided in patients with hypersensitivity to amphotericin B or any liposomal components.

Pharmacology: The liposomal formulation favors greater distribution to fungal tissues and central nervous system and reduces renal exposure, contributing to improved tolerability and a distinct pharmacokinetic profile compared with conventional amphotericin B.