Amphotericin B: Brands, Price & Uses in Bangladesh

Amphotericin B is a polyene antifungal used for the treatment of serious, systemic, and often life-threatening fungal infections. Its use is generally reserved for confirmed or strongly suspected invasive fungal disease, under specialist (infectious disease) supervision.

Established / guideline-supported uses (intravenous formulations)

• Invasive candidiasis (including candidemia), especially when azole resistance is suspected or in critically ill patients
• Invasive aspergillosis, particularly as alternative therapy when first-line azole therapy (e.g., voriconazole) is not tolerated or has failed
• Cryptococcal meningitis (typically used in combination with flucytosine as induction therapy)
• Histoplasmosis, blastomycosis, and coccidioidomycosis (moderate-to-severe or disseminated disease)
• Mucormycosis (first-line therapy for this typically resistant mould infection)
• Visceral leishmaniasis (liposomal formulation specifically indicated for this)
• Empirical antifungal therapy in persistently febrile, neutropenic patients when no other cause of fever is found

Localized / non-systemic uses (topical and oral non-absorbed formulations)

• Cutaneous and mucocutaneous candidiasis (topical preparations)
• Oral/gastrointestinal candidiasis limited to the gut lumen (non-absorbed oral suspension, where available)

Note: Amphotericin B is not used for minor, localized, or non-life-threatening fungal infections when safer, better-tolerated alternatives (e.g., azoles, echinocandins) are suitable.

Dosing of Amphotericin B varies substantially by formulation (conventional deoxycholate vs. lipid-based), indication, and patient factors, and must be individualized by a specialist. Representative ranges are summarized below; actual prescribing should follow the specific product labeling and institutional protocols.

Administration

• Given by slow intravenous infusion; rate and duration depend on formulation and patient tolerance
• A small test dose is sometimes used before the first full dose to assess for severe infusion reactions, per institutional protocol
• Premedication (antipyretics, antihistamines, sometimes corticosteroids or antiemetics) is commonly used, especially for early doses, to reduce infusion-related reactions
• Adequate hydration and sodium loading before each infusion (where not contraindicated) can help reduce the risk of nephrotoxicity with the conventional formulation
• Duration of therapy depends on the infection, clinical and mycological response, and is determined by the treating specialist (see Duration of Treatment)

Stewardship note: Amphotericin B must be given exactly as prescribed by the treating physician. Doses should never be stopped early, extended, skipped, adjusted, or shared with another person without direct medical advice, as inappropriate use can worsen infection outcomes and promote antifungal resistance.

Side effects of Amphotericin B are common, particularly with the conventional (deoxycholate) formulation, and range from infusion-related reactions to more serious organ toxicities.

Very common

• Infusion-related reactions: fever, chills/rigors, headache, myalgia, nausea, vomiting, and hypotension during or shortly after infusion
• Phlebitis/thrombophlebitis at the infusion site

Common / clinically important

• Nephrotoxicity: decreased kidney function, renal tubular acidosis, electrolyte wasting (see below) — the major dose-limiting toxicity of the conventional formulation (see Precautions and Warnings)
• Electrolyte disturbances: hypokalemia and hypomagnesemia
• Anemia (due to decreased erythropoietin production with prolonged use)
• Hepatotoxicity: abnormal liver function tests

Less common but serious

• Cardiac arrhythmias, particularly with rapid infusion rates
• Anaphylaxis and severe hypersensitivity reactions
• Bronchospasm