Polyene systemic antifungal
ATC code: J02AA01 (Amphotericin B)
Brand names
Fungizone, AmBisome, Abelcet
Binds ergosterol in fungal cell membranes, forming pores through which the cell loses ions and metabolites. Active against most pathogenic fungi: Candida, Aspergillus, Cryptococcus, Mucorales, Histoplasma. Not significantly metabolised, slowly excreted. Main adverse effects are dose-dependent nephrotoxicity, hypokalaemia, hypomagnesaemia and infusion reactions with fever and chills. Liposomal formulations (AmBisome) reduce toxicity.
First line
Amphotericin B is first-line antifungal for severe systemic mycoses: cryptococcal meningitis, mucormycosis, severe invasive candidiasis and aspergillosis, visceral leishmaniasis. 2024 and SEIMC recommend liposomal formulation (AmBisome) as standard due to lower nephrotoxicity than deoxycholate Fungizone. With long-term use – check creatinine, potassium and magnesium every other day for the first 2 weeks.
3 pairs found. Sorted from critical to minor.
Mechanism
Amphotericin B causes hypokalaemia, which enhances digoxin binding to cardiomyocyte Na-K-ATPase and potentiates digoxin toxicity.
Symptoms
Bradycardia, arrhythmia, yellow vision.
Management
Check potassium and digoxin levels. Replacement therapy.
Mechanism
Both nephrotoxic. Combined use gives additive AKI risk.
Symptoms
Creatinine rise within 5-7 days.
Management
Daily creatinine monitoring, minimise course duration.
Mechanism
Both cause renal potassium loss. Dual hypokalaemia with arrhythmia risk.
Symptoms
K+ below 3.0 mmol/L, weakness, arrhythmia.
Management
Daily potassium check, potassium and magnesium replacement.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
May be used in life-threatening mycoses in pregnancy; teratogenic risk is low. AmBisome preferred.
No milk excretion data. Oral bioavailability in infant minimal.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Amphotericin B is evaluated for the following indications with varying evidence strength: Systemic fungal infection (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Amphotericin B (≥ 1 in 100): Fever and chills during infusion, Nausea, vomiting, Hypokalaemia, hypomagnesaemia, Rising creatinine, Anaemia. See the Safety section for uncommon and serious reactions.
FDA category B. May be used in life-threatening mycoses in pregnancy; teratogenic risk is low. AmBisome preferred.
No milk excretion data. Oral bioavailability in infant minimal.
Amphotericin B is contraindicated in: Amphotericin hypersensitivity; Severe renal impairment (eGFR below 30 mL/min) – relative contraindication for deoxycholate form. Full list in the Safety section.