Liposomal amphotericin B
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| ID | DRUG-LIPOSOMAL-AMPHOTERICIN-B |
|---|---|
| Тип | Препарат |
| Синоніми | AmBisomeAmbisomeL-AmBLAmBЛіпосомальний амфотерицин B |
| Статус | переглянуто 2026-04-27 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Дані про препарат
| Клас | Polyene macrolide antifungal (broad-spectrum, including Mucorales) — liposome-encapsulated formulation for reduced nephrotoxicity |
|---|---|
| Механізм дії | Polyene macrolide that binds ergosterol in the fungal cell membrane, forming transmembrane channels that disrupt membrane integrity, allow leakage of intracellular contents (potassium, magnesium), and produce fungicidal activity. Liposomal encapsulation in unilamellar vesicles (~80 nm) preferentially delivers amphotericin to fungal cells via ergosterol affinity while sparing mammalian cell membranes (which contain cholesterol with lower amphotericin affinity), markedly reducing nephrotoxicity, infusion reactions, and electrolyte wasting vs conventional amphotericin B deoxycholate. Broadest spectrum of any antifungal: most Candida (including azole-resistant), Aspergillus (active, fungicidal), Cryptococcus, ENDEMIC mycoses (Histoplasma, Blastomyces, Coccidioides, Sporothrix), AND Mucorales (Mucor, Rhizopus, Lichtheimia, Cunninghamella) — the latter is critical because echinocandins and mo... |
| Типове дозування | Empirical antifungal in persistent FN (adult): 3 mg/kg IV once daily over 60-120 min infusion. Documented invasive aspergillosis: 5 mg/kg IV daily. Mucormycosis: 5-10 mg/kg IV daily — higher doses (10 mg/kg) often used initially for CNS or rhino-orbital-cerebral involvement until clinical response. Cryptococcal meningitis induction: 3-4 mg/kg IV daily + flucytosine 100 mg/kg/day PO × 2 weeks. Visceral leishmaniasis: 3 mg/kg IV daily × 5 days, then day 14 and day 21. Pediatric: same mg/kg dosing. Renal: no formal dose adjustment but monitor renal function closely; nephrotoxicity reduced vs conventional ~75% but NOT eliminated. Hepatic: no adjustment. Premedication for infusion reaction (less... |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | True |
| Остання перевірка для України | 2026-04-27 |
Нотатки
The ONLY broad antifungal with robust Mucorales activity — first-line for documented mucormycosis (rhino-orbital-cerebral, pulmonary, cutaneous) where no echinocandin or fluconazole-class alternative works. Also first-line for visceral leishmaniasis and induction therapy for cryptococcal meningitis. In febrile neutropenia, alternative to echinocandin when echinocandin spectrum gaps are concerning (Mucor, Cryptococcus, Trichosporon, Fusarium suspected), patient is intolerant to echinocandins, or response failure to empirical echinocandin. CRITICAL: ALWAYS prescribe AmBisome (liposomal) — NOT amphotericin B deoxycholate (conventional); conventional formulation has 50%+ nephrotoxicity rate and severe infusion reactions, supplanted by liposomal in essentially all modern oncology contexts. Reconstitute and dilute in D5W only — precipitation occurs in saline. Monitor K+, Mg++ daily and pre-emptively replace; renal function 2-3× weekly. Liposomal preserves spectrum + activity vs conventional with substantially better tolerability. Ukraine: registered, NSZU-covered; specify AmBisome on prescriptions to avoid pharmacy substitution with conventional formulation.
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