Amphotericin B (AmBisome®) Protocol

Written by: Rebecca Tims and Andrew Hanzlicek

Indications: Treatment of progressive or life-threatening invasive fungal infections.

Reconstitution: (According to package insert). Aseptically add 12ml STERILE WATER to AmBisome vial to yield a preparation containing 4mg/mL. SHAKE THE VIAL VIGOROUSLY for 30 seconds to completely disperse AmBisome. It will be a yellow translucent suspension after mixing. Make sure that no particulate matter is observed, if so, continue shaking.

Storage: Stable in refrigerator (protected from light) for up to 7 days after initial reconstitution to 4mg/ml.

Dosing: Typical dosing for dogs: 1-2mg/kg every other day to a maximum cumulative dose of 24mg/kg.

Typical dosing for cats: 0.5-1 mg/kg every other day to a maximum cumulative dose of 12mg/kg. A dose much below the maximum cumulative dose can be beneficial. Evaluate kidney values and electrolytes before each dose. If kidney values are increasing, even within the reference interval delay the dose. If not already on IV fluids administer 2x maintenance 30 minutes before and 2 hours after drug infusion.

Administration: Calculate desired dose of 4mg/ml solution, draw up in sterile syringe, and then attach the provided 5-micron filter. Filter cannot be smaller than 1-micron. AmBisome must be diluted with 5% dextrose in water (D5W) to a final concentration of 1-2mg/ml. In cats and small dogs, a syringe pump is typically used, in larger dogs; bags of D5W can be used with an appropriate pump. Administer over 2-6 hours.

Note: Must flush IV catheter with D5W before and after administration. If flushing during administration, use D5W.

Compatibility: D5W

Incompatibility: Calcium gluconate, cimetidine, diphenhydramine, dopamine, calcium EDTA, lidocaine, potassium chloride.

Adverse Effects: Nephrotoxicity, anorexia, vomiting, hypokalemia, hypomagnesaemia, phlebitis, arrhythmias, anemia.

Monitoring: Monitor TPR at least hourly during administration. Evaluate kidney values and electrolytes before each dose.