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chapter 27 Polyenes 173
1.5 mg/kg/day, where the lipid formulations are
dosed at 3–6 mg/kg/day. Whether the lipid formulations
are equivalent is a matter of debate, but most
clinicians dose them as if they are. Fatal overdoses
of amphotericin B deoxycholate occurred when
dosed as the lipid forms are—generally a 53 overdose.
Mind your formulation.
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Important Facts
• Amphotericin B nephrotoxicity can be attenuated
by the process of sodium loading: administered
boluses of normal saline before and after
the amphotericin infusion. Sodium loading is
an inexpensive and easy way of protecting the
kidneys.
• Many practitioners administer such drugs as
acetaminophen, diphenhydramine, and hydrocortisone
to decrease the incidence and severity
of infusion-related reactions of amphotericin B.
Meperidine is often given to treat rigors when
they develop, but be wary of using this drug
in patients who develop renal dysfunction
because it has a neurotoxic metabolite that is
eliminated renally.
• Whether differences in efficacy exist between
the lipid formulations of amphotericin B is a
matter of debate, but differences in safety do
exist. In terms of infusion-related reactions,
ABCD seems to have the worst, while LAmB
has the least. All of them have less nephrotoxicity
than amphotericin B deoxycholate, but
LAmB seems to have the least of all.
• Nystatin is used only topically due to poor tolerance
when given systemically.