Amphotericin B liposomal drug interactions: Difference between revisions
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==Drug-Laboratory Interactions== | ==Drug-Laboratory Interactions== | ||
*'''Serum phosphate false elevation''' | * '''Serum phosphate false elevation''' | ||
False elevations of serum phosphate may occur when samples from patients receiving AmBisome are analyzed using the PHOSm assay (e.g. used in Beckman Coulter analyzers including the Synchron LX20). This assay is intended for the quantitative determination of inorganic phosphorus in human serum, plasma or urine samples. | False elevations of serum phosphate may occur when samples from patients receiving AmBisome are analyzed using the PHOSm assay (e.g. used in Beckman Coulter analyzers including the Synchron LX20). This assay is intended for the quantitative determination of inorganic phosphorus in human serum, plasma or urine samples. | ||
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No formal clinical studies of drug interactions have been conducted with AmBisome. However, the following drugs are known to interact with amphotericin B and may interact with AmBisome: | No formal clinical studies of drug interactions have been conducted with AmBisome. However, the following drugs are known to interact with amphotericin B and may interact with AmBisome: | ||
*'''Antineoplastic Agents''' | * '''Antineoplastic Agents''' | ||
Concurrent use of antineoplastic agents may enhance the potential for renal toxicity, bronchospasm, and hypotension. Antineoplastic agents should be given concomitantly with caution. | Concurrent use of antineoplastic agents may enhance the potential for renal toxicity, [[bronchospasm]], and [[hypotension]]. Antineoplastic agents should be given concomitantly with caution. | ||
*'''Corticosteroids and Corticotropin (ACTH)''' | * '''Corticosteroids and Corticotropin (ACTH)''' | ||
Concurrent use of corticosteroids and ACTH may potentiate hypokalemia which could predispose the patient to cardiac dysfunction. If used concomitantly, serum electrolytes and cardiac function should be closely monitored. | Concurrent use of [[corticosteroids]] and [[ACTH]] may potentiate [[hypokalemia]] which could predispose the patient to cardiac dysfunction. If used concomitantly, serum electrolytes and cardiac function should be closely monitored. | ||
*'''Digitalis Glycosides''' | * '''Digitalis Glycosides''' | ||
Concurrent use may induce hypokalemia and may potentiate digitalis toxicity. When administered concomitantly, serum potassium levels should be closely monitored. | Concurrent use may induce hypokalemia and may potentiate [[digitalis toxicity]]. When administered concomitantly, serum potassium levels should be closely monitored. | ||
*'''Flucytosine''' | * '''Flucytosine''' | ||
Concurrent use of flucytosine may increase the toxicity of flucytosine by possibly increasing its cellular uptake and/or impairing its renal excretion. | Concurrent use of flucytosine may increase the toxicity of [[flucytosine]] by possibly increasing its cellular uptake and/or impairing its renal excretion. | ||
*'''Azoles''' (e.g. | * '''Azoles''' (e.g. [[ketoconazole]], [[miconazole]], [[clotrimazole]], [[fluconazole]], etc.) | ||
In vitro and in vivo animal studies of the combination of amphotericin B and imidazoles suggest that imidazoles may induce fungal resistance to amphotericin B. Combination therapy should be administered with caution, especially in immunocompromised patients. | In vitro and in vivo animal studies of the combination of amphotericin B and imidazoles suggest that imidazoles may induce fungal resistance to amphotericin B. Combination therapy should be administered with caution, especially in immunocompromised patients. | ||
*'''Leukocyte Transfusions''' | * '''Leukocyte Transfusions''' | ||
Acute pulmonary toxicity has been reported in patients simultaneously receiving intravenous amphotericin B and leukocyte transfusions. | Acute pulmonary toxicity has been reported in patients simultaneously receiving [[intravenous]] amphotericin B and leukocyte transfusions. | ||
*Other '''Nephrotoxic Medications''' | * Other '''Nephrotoxic Medications''' | ||
Concurrent use of amphotericin B and other nephrotoxic medications may enhance the potential for drug-induced renal toxicity. Intensive monitoring of renal function is recommended in patients requiring any combination of nephrotoxic medications. | Concurrent use of amphotericin B and other [[nephrotoxic]] medications may enhance the potential for drug-induced renal toxicity. Intensive monitoring of renal function is recommended in patients requiring any combination of nephrotoxic medications. | ||
*'''Skeletal Muscle Relaxants''' | * '''Skeletal Muscle Relaxants''' | ||
Amphotericin B-induced hypokalemia may enhance the curariform effect of skeletal muscle | Amphotericin B-induced [[hypokalemia]] may enhance the curariform effect of skeletal [[muscle relaxant]]s (e.g. [[tubocurarine]]) due to [[hypokalemia]]. When administered concomitantly, serum potassium levels should be closely monitored.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = AMBISOME (AMPHOTERICIN B) INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION [ASTELLAS PHARMA US, INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f7be6506-4d20-401e-a0ff-02ad7c33158a | publisher = | date = | accessdate = }}</ref> | ||
<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = AMBISOME (AMPHOTERICIN B) INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION [ASTELLAS PHARMA US, INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f7be6506-4d20-401e-a0ff-02ad7c33158a | publisher = | date = | accessdate = }}</ref> | |||
==References== | ==References== | ||
Latest revision as of 23:36, 16 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]
Drug-Laboratory Interactions
- Serum phosphate false elevation
False elevations of serum phosphate may occur when samples from patients receiving AmBisome are analyzed using the PHOSm assay (e.g. used in Beckman Coulter analyzers including the Synchron LX20). This assay is intended for the quantitative determination of inorganic phosphorus in human serum, plasma or urine samples.
Drug Interactions
No formal clinical studies of drug interactions have been conducted with AmBisome. However, the following drugs are known to interact with amphotericin B and may interact with AmBisome:
- Antineoplastic Agents
Concurrent use of antineoplastic agents may enhance the potential for renal toxicity, bronchospasm, and hypotension. Antineoplastic agents should be given concomitantly with caution.
- Corticosteroids and Corticotropin (ACTH)
Concurrent use of corticosteroids and ACTH may potentiate hypokalemia which could predispose the patient to cardiac dysfunction. If used concomitantly, serum electrolytes and cardiac function should be closely monitored.
- Digitalis Glycosides
Concurrent use may induce hypokalemia and may potentiate digitalis toxicity. When administered concomitantly, serum potassium levels should be closely monitored.
- Flucytosine
Concurrent use of flucytosine may increase the toxicity of flucytosine by possibly increasing its cellular uptake and/or impairing its renal excretion.
- Azoles (e.g. ketoconazole, miconazole, clotrimazole, fluconazole, etc.)
In vitro and in vivo animal studies of the combination of amphotericin B and imidazoles suggest that imidazoles may induce fungal resistance to amphotericin B. Combination therapy should be administered with caution, especially in immunocompromised patients.
- Leukocyte Transfusions
Acute pulmonary toxicity has been reported in patients simultaneously receiving intravenous amphotericin B and leukocyte transfusions.
- Other Nephrotoxic Medications
Concurrent use of amphotericin B and other nephrotoxic medications may enhance the potential for drug-induced renal toxicity. Intensive monitoring of renal function is recommended in patients requiring any combination of nephrotoxic medications.
- Skeletal Muscle Relaxants
Amphotericin B-induced hypokalemia may enhance the curariform effect of skeletal muscle relaxants (e.g. tubocurarine) due to hypokalemia. When administered concomitantly, serum potassium levels should be closely monitored.[1]
References
Adapted from the FDA Package Insert.