INDICATIONS

FORMS

*Prices represent cost per unit specified, are representative of "Average Wholesale Price" (AWP).
^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

• 5mg/kg/day IV
• For obese patients: consider ideal body weight (limited data)

PEDIATRIC DOSING

RENAL DOSING

ADVERSE DRUG REACTIONS

DRUG INTERACTIONS

• Digoxin: potential increase in digitalis toxicity secondary to amphotericin-induced potassium depletion. Monitor potassium closely with co-administration.
• Diuretics: may result in additive hypokalemia. Monitor potassium closely with co-administration.
• Nephrotoxic agents (aminoglycosides, cidofovir, foscarnet, pentamidine): may result in additive nephrotoxicity. Avoid co-administration or use with close monitoring.
• Pentamidine: potential for additive hypocalcemia and/or nephrotoxicity. Avoid co-administration or use with close monitoring.
• Skeletal muscle relaxants: may enhance curariform effect of skeletal muscle relaxants (e.g., tubocurarine) due to hypokalemia. Monitor potassium closely with co-administration.

SPECTRUM

Includes Aspergillus spp (A. fumigatus, A. flavus), Candida spp. (C. albicans, C. krusei, C. parapsilosis, C. tropicalis), Cryptococcus neoformans, and Blastomyces dermatitidis.

RESISTANCE

Active against most fungi with the notable exceptions of Candida lusitaniae, Trichosporon beigelii, Aspergillus terreus (some isolates), Pseudallescheria boydii, Scedosporium prolificans, Malassezia furfur and many Fusarium spp.

PHARMACOLOGY

COMMENTS

• Abelcet has comparable cost to Amphotec but generally better tolerated with less infusion related reactions.
• Abelcet has comparable cost to AmBisome, but resulted in a higher incidence of nephrotoxicity and infusion related side effects.

References

1. Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(3):327-60.  [PMID:18177225]

   Comment: The IDSA guidelines recommend Ambisome (3â??5 mg/kg/day IV) or Abelcet (5 mg/ kg/day IV) as alternatives to voriconazole for the treatment of invasive aspergillosis.
   

2. Würthwein G, Groll AH, Hempel G, et al. Population pharmacokinetics of amphotericin B lipid complex in neonates. Antimicrob Agents Chemother. 2005;49(12):5092-8.  [PMID:16304177]

   Comment: Abelcet dosed at 2.5-5 mg/kg/day is recommended in neonates for the treatment of invasive candidiasis.
   

3. Fleming RV, Kantarjian HM, Husni R, et al. Comparison of amphotericin B lipid complex (ABLC) vs. ambisome in the treatment of suspected or documented fungal infections in patients with leukemia. Leuk Lymphoma. 2001;40(5-6):511-20.  [PMID:11426524]

   Comment: This is a prospective, randomized trial comparing the safety and efficacy of Abelcet vs. Ambisome for the treatment of suspected or documented fungal infections in 82 patients with leukemia. The overall response to therapy was 27/43 (63%) for Abelcet and 15/39 (39%) for Ambisome (p=0.03). It is important to note that patients in the Ambisome arm were sicker (i.e more with Fusarium spp .). Patients receiving Abelcet had more infusion related toxicity, whereas patients receiving Ambisome had a higher incidence of bilirubin elevation.
   

4. Wingard JR, White MH, Anaissie E, et al. A randomized, double-blind comparative trial evaluating the safety of liposomal amphotericin B versus amphotericin B lipid complex in the empirical treatment of febrile neutropenia. L Amph/ABLC Collaborative Study Group. Clin Infect Dis. 2000;31(5):1155-63.  [PMID:11073745]

   Comment: In this prospective, randomized trial, nephrotoxicity (3x above baseline) was noted in 6.2% and 26.9% of patients receiving Ambisome and Abelcet, respectively (p<0.001). Chills and rigors were reported in 50.5% in the Abelcet arm and 24.3% in the ambisome arm(p<0.001)). Ambisome, at a higher cost, has a lower incidence of nephrotoxicity and infusion related toxicity. It is however interesting to note that ADR reported with Abelcet in this trial is 2-fold higher than historical rates.
   

5. Walsh TJ, Seibel NL, Arndt C, et al. Amphotericin B lipid complex in pediatric patients with invasive fungal infections. Pediatr Infect Dis J. 1999;18(8):702-8.  [PMID:10462340]

   Comment: Abelcet at a dosage of 5 mg/kg/day was well tolerated in 111 pediatric patients who were enrolled in this open label compassionate use protocol.
   

6. Sharkey PK, Graybill JR, Johnson ES, et al. Amphotericin B lipid complex compared with amphotericin B in the treatment of cryptococcal meningitis in patients with AIDS. Clin Infect Dis. 1996;22(2):315-21.  [PMID:8838189]

   Comment: Clinical improvement occurred in 86% of patients treated with Abelcet even though CSF sterilization was achieved in 42% after 2 weeks of therapy. This small study suggests that there may be a role for Abelcet in the treatment of cryptococcal meningitis , however larger trials need to be conducted.