Amphotericin B

Polyene systemic antifungal

ATC code: J02AA01

Brand names: Fungizone, AmBisome, Abelcet

Updated 4 Jun 2026 · Methodology

Indications

Systemic fungal infection

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.

Sources

ICD-10: B49 · ICD-11: 1F2Z

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

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.

Safety

Contraindications

Amphotericin hypersensitivity
Severe renal impairment (eGFR below 30 mL/min) – relative contraindication for deoxycholate form

Serious adverse effects

Acute kidney injury
Arrhythmia from hypokalaemia
Anaphylactoid reactions
Severe infusion reaction

Common adverse effects

Fever and chills during infusion
Nausea, vomiting
Hypokalaemia, hypomagnesaemia
Rising creatinine
Anaemia

Pregnancy: can you take Amphotericin B?

May be used in life-threatening mycoses in pregnancy; teratogenic risk is low. AmBisome preferred.

Breastfeeding: can you take Amphotericin B?

No milk excretion data. Oral bioavailability in infant minimal.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Drug–drug interactions

3 pairs found. Sorted from critical to minor.

MajorDigoxinCardiac glycosides (digitalis)

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.

Sources

FDA: Fungizone (amphotericin B) prescribing information (2014)

Pair details →Digoxin →

MajorGentamicinAminoglycoside antibiotic

Mechanism

Both nephrotoxic. Combined use gives additive AKI risk.

Symptoms

Creatinine rise within 5-7 days.

Management

Daily creatinine monitoring, minimise course duration.

Sources

Pair details →Gentamicin →

MajorHydrochlorothiazideThiazide diuretics

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.

Sources

Pair details →Hydrochlorothiazide →

Label mentions25 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

Moderateantineoplasticsclass named in the label
«Drug Interactions: Concurrent use of antineoplastic agents may enhance the potential for renal toxicity, bronchospasm, and hypotension. Antineoplastic agents should be given concomitantly with…»
FDA, section 7 · Open on DailyMed
Moderateazole antifungalsclass named in the label
«Drug Interactions: Azoles (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.) In vitro and in vivo animal studies of the combination of amphotericin B and imidazoles suggest that…»
FDA, section 7 · Open on DailyMed
ModerateClotrimazole
«Drug Interactions: Azoles (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.) In vitro and in vivo animal studies of the combination of amphotericin B and imidazoles suggest that…»
FDA, section 7 · Open on DailyMed
Moderatecorticosteroidsclass named in the label
«Drug Interactions: Concurrent use of corticosteroids and ACTH may potentiate hypokalemia, which could predispose the patient to cardiac dysfunction. If used concomitantly, serum electrolytes and…»
FDA, section 7 · Open on DailyMed
Moderatedigitalisclass named in the label
«Drug Interactions: Concurrent use may induce hypokalemia and may potentiate digitalis toxicity. When administered concomitantly, serum potassium levels should be closely monitored.»
FDA, section 7 · Open on DailyMed
ModerateFluconazole
«Drug Interactions: Azoles (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.) In vitro and in vivo animal studies of the combination of amphotericin B and imidazoles suggest that…»
FDA, section 7 · Open on DailyMed
ModerateKetoconazole
«Drug Interactions: Azoles (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.) In vitro and in vivo animal studies of the combination of amphotericin B and imidazoles suggest that…»
FDA, section 7 · Open on DailyMed
ModerateMiconazole
«Drug Interactions: Azoles (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.) In vitro and in vivo animal studies of the combination of amphotericin B and imidazoles suggest that…»
FDA, section 7 · Open on DailyMed
Moderatemuscle relaxantsclass named in the label
«Drug Interactions: Amphotericin B-induced hypokalemia may enhance the curariform effect of skeletal muscle relaxants (e.g. tubocurarine) due to hypokalemia. When administered concomitantly, serum…»
FDA, section 7 · Open on DailyMed

From other drugs’ labels

MajorGentamicin
«Fármacos potencialmente nefrotóxicos u ototóxicos: Debido al mayor riesgo de efectos no deseados, se requiere una cuidadosa supervisión de los pacientes que reciben tratamiento simultáneo o…»
AEMPS, section 4.5 · Open on CIMA
MajorHydrochlorothiazide
«Administración concomitante no recomendada: La administración concomitante de hidroclorotiazida y medicamentos asociados a pérdida de potasio e hipopotasemia, p.ej., diuréticos caliuréticos (p.ej…»
AEMPS, section 4.5 · Open on CIMA
ModerateBetamethasone
«Otros hipokalemiantes (diuréticos hipokalemiantes solos o en asociación, laxantes estimulantes, anfotericina B IV).»
AEMPS, section 4.5 · Open on CIMA
ModerateChlortalidone
«Inhibidores de la ECA (por ejemplo, captopril, enalapril): Diuréticos kaliuréticos (p. ej., furosemida), glucocorticoides, ACTH, carbenoxolona, penicilina G, salicilatos, laxantes estimulantes…»
AEMPS, section 4.5 · Open on CIMA
ModerateCiclosporin
«Combinaciones con mayor riesgo de nefrotoxicidad: Deberá tenerse precaución cuando se utilice ciclosporina junto con otros fármacos que presentan sinergia nefrotóxica como son: aminoglucósidos…»
AEMPS, section 4.5 · Open on CIMA
ModerateDexamethasone
«El efecto hipopotasémico de la acetazolamida, diuréticos de asa, diuréticos tiazídicos, kaliuréticos, inyecciones de anfotericina B, corticosteroides glucominerales, tetracosactida y laxantes puede…»
AEMPS, section 4.5 · Open on CIMA
ModerateHydrocortisone
«Interacción/Efecto: Cuando se administran corticosteroides concomitantemente con agentes que reducen el potasio (es decir, diuréticos), se debe vigilar estrechamente a los pacientes para detectar el…»
AEMPS, section 4.5 · Open on CIMA
ModerateIndapamide
«Otros fármacos que causan hipopotasemia: anfotericina B (IV), gluco y mineralocorticoides (sistémicos), tetracosactida, laxantes estimulantes:»
AEMPS, section 4.5 · Open on CIMA
ModerateMethylprednisolone
«- Anfotericina B: posible aumento de la hipopotasemia, con riesgo de toxicidad. Se deben vigilar los niveles plasmáticos de potasio.»
AEMPS, section 4.5 · Open on CIMA
ModerateMoxifloxacin
«Interacciones con otros medicamentos: Se debe utilizar moxifloxacino con precaución en pacientes que están tomando medicación que puede reducir los niveles de potasio (p. ej., diuréticos de asa y…»
AEMPS, section 4.5 · Open on CIMA
ModeratePrednisolone
«Anfotericina B: posible aumento de la hipocalemia, con riesgo de toxicidad. Se deben vigilar los niveles plasmáticos de potasio.»
AEMPS, section 4.5 · Open on CIMA
ModerateSotalol
«Anfotericina B (i.v.), corticosteroides (sistémicos) y algunos laxantes se asocian también a la hipopotasemia; en caso de administración concomitante con sotalol, deben controlarse los niveles de…»
AEMPS, section 4.5 · Open on CIMA
Acetylcysteine
«Antibióticos: Si se administra acetilcisteína junto con antibióticos como anfotericina B, ampicilina sódica, cefalosporinas, lactobionato de eritromicina o algunas tetraciclinas, pueden ser…»
AEMPS, section 4.5 · Open on CIMA
Clotrimazole
«Drug Interactions: Synergism or antagonism between clotrimazole and nystatin, or amphotericin B, or flucytosine against strains of C. albicans has not been reported.»
FDA, section 7 · Open on DailyMed
Dexamethasone
«Drug Interactions: Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents (e.g., amphotericin B, diuretics)…»
FDA, section 7 · Open on DailyMed
Tacrolimus
«Recomendaciones relativas a la a dministración simultánea: Productos con efectos nefrotóxicos o neurotóxicos conocidos: aminoglicósidos, inhibidores de girasa, vancomicina sulfametoxazol +…»
AEMPS, section 4.5 · Open on CIMA

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Frequently asked

What is Amphotericin B used for?

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.

What are the side effects of Amphotericin B?

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.

Is Amphotericin B safe during pregnancy?

May be used in life-threatening mycoses in pregnancy; teratogenic risk is low. AmBisome preferred.

Is Amphotericin B compatible with breastfeeding?

No milk excretion data. Oral bioavailability in infant minimal.

Who should not take Amphotericin B?

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.

Official sources

Direct links to regulator labels. Open in a new tab.

FDA / DailyMedLabel dated 04/20/2026

Other drugs in this group

Fluconazole, Isavuconazole, Itraconazole, Ketoconazole, Posaconazole, Voriconazole