LIMITED ACCESS DRUG
CLASSIFICATION
Antifungal antibiotic
ALTERNATE NAMES
ABELCET, ABLC
INDICATIONS
- treatment of progressive, potentially fatal disseminated mycotic
infections in patients who are refractory to or intolerant of conventional
amphotericin B therapy
- restricted
to consult by Infectious Diseases Service and CSU Pharmaceutical Sciences;
BMT, SOT and ICU patients exempt from Infectious Diseases Consult. Orders
must be prescribed using an amphtericin B lipid complex pre-printed order (PPO).
This PPO contains creatinine clearance thresholds whereupon this agent may
be ordered.
RECONSTITUTION AND STABILITY
- refrigerate; protect vial from light
- diluted solution stable for 6 hours at room temperature and 24 hours in
refrigerator
COMPATIBILITY
- use D5W only for infusion solution
- dilute to 0.5-2 mg/mL concentration in 250-500mL D5W
- do not administer with an in-line filter
- incompatible with other drugs
- flush all lines with D5W
ROUTES OF ADMINISTRATION
- IV intermittent - dilute to 0.5-2 mg/mL in 250-500mL D5W
- infuse at rate of 2.5mg/kg/hour
- shake bag at start of infusion and every 2 hours if infusion longer than 2
hours to resuspend contents
VH & HSC ADMINISTRATION POLICY
A - Not to be administered by the direct IV route
H- The IV administration rate must be controlled by an automated infusion
control device.
DOSAGE
- 5mg/kg IV as a once daily infusion.
- dosage may need to be reduced in renal failure, however there are not
guidelines for dosage adjustment based on serum creatinine. The decision
about dosage adjustments should be based on the overall clinical condition
of the patient.
POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION
- acute reactions including fever and chills may occur 1-2 hours after
initiation of the infusion. These reactions are more common with the first
few doses and generally diminish with subsequent doses. Premedication with
analgesics, antiemetics, antihistamines and hydrocortisone may be required.
- anaphylaxis, hypotension, bronchospasm, arrhythmias, and shock are rare
IMPORTANT IMPLICATIONS
- serum creatinine, BUN, urinalysis, blood counts and electrolytes should be
monitored closely
- despite generally less nephrotoxicity with amphotericin B lipid complex
compared to conventional amphotericin B, dose limiting renal toxicity may
still be observed
- concomitant use of nephrotoxic agents should be undertaken with caution
- may cause hypokalemia, hypomagnesemia, and hypocalcemia
