Amphotericin B drug interactions: Difference between revisions
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'''Corticosteroid''' and '''corticotropin''' (ACTH): Concurrent use of [[corticosteroids]] and [[corticotropin]] ([[ACTH]]) with amphotericin B may potentiate [[hypokalemia]] which could predispose the patient to cardiac dysfunction. If used concomitantly with ABELCET®, serum electrolytes and cardiac function should be closely monitored. | '''Corticosteroid''' and '''corticotropin''' (ACTH): Concurrent use of [[corticosteroids]] and [[corticotropin]] ([[ACTH]]) with amphotericin B may potentiate [[hypokalemia]] which could predispose the patient to cardiac dysfunction. If used concomitantly with ABELCET®, serum electrolytes and cardiac function should be closely monitored. | ||
'''Cyclosporin A''': Data from a prospective study of prophylactic ABELCET® in 22 patients undergoing bone marrow transplantation suggested that concurrent initiation of cyclosporin A and ABELCET® within several days of bone marrow ablation may be associated with increased [[nephrotoxicity]]. | '''Cyclosporin A''': Data from a prospective study of prophylactic ABELCET® in 22 patients undergoing [[bone marrow transplantation]] suggested that concurrent initiation of [[cyclosporin A]] and ABELCET® within several days of bone marrow ablation may be associated with increased [[nephrotoxicity]]. | ||
'''Digitalis glycosides''': Concurrent use of amphotericin B may induce hypokalemia and may potentiate digitalis toxicity. When administered concomitantly with ABELCET®, serum potassium levels should be closely monitored. | '''Digitalis glycosides''': Concurrent use of amphotericin B may induce [[hypokalemia]] and may potentiate [[digitalis toxicity]]. When administered concomitantly with ABELCET®, serum [[potassium]] levels should be closely monitored. | ||
'''Flucytosine''': Concurrent use of flucytosine with amphotericin B-containing preparations may increase the toxicity of flucytosine by possibly increasing its cellular uptake and/or impairing its renal excretion. Flucytosine should be given concomitantly with ABELCET® with caution. | '''Flucytosine''': Concurrent use of [[flucytosine]] with amphotericin B-containing preparations may increase the toxicity of flucytosine by possibly increasing its cellular uptake and/or impairing its renal excretion. [[Flucytosine]] should be given concomitantly with ABELCET® with caution. | ||
'''Imidazoles''' (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.): Antagonism between amphotericin B and imidazole derivatives such as miconazole | '''Imidazoles''' (e.g., [[ketoconazole]], [[miconazole]], [[clotrimazole]], [[fluconazole]], etc.): Antagonism between amphotericin B and imidazole derivatives such as [[miconazole]] nd [[ketoconazole]], which inhibit [[ergosterol]] synthesis, has been reported in both in vitro and in vivo animal studies. The clinical significance of these findings has not been determined. | ||
'''Leukocyte transfusions''': Acute pulmonary toxicity has been reported in patients receiving intravenous amphotericin B and leukocyte transfusions. Leukocyte transfusions and ABELCET® should not be given concurrently. | '''Leukocyte transfusions''': Acute pulmonary toxicity has been reported in patients receiving [[intravenous]] amphotericin B and leukocyte transfusions. Leukocyte transfusions and ABELCET® should not be given concurrently. | ||
Other '''nephrotoxic medications''': Concurrent use of amphotericin B and agents such as | Other '''nephrotoxic medications''': Concurrent use of amphotericin B and agents such as [[aminoglycosides]] and [[pentamidine]] may enhance the potential for drug-induced renal toxicity. [[Aminoglycosides]] and [[pentamidine]] should be used concomitantly with ABELCET® only with great caution. 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 with ABELCET®, serum potassium levels should be closely monitored. | '''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 with ABELCET®, serum potassium levels should be closely monitored. | ||
'''Zidovudine''': Increased myelotoxicity and nephrotoxicity were observed in dogs when either ABELCET® (at doses 0.16 or 0.5 times the recommended human dose) or amphotericin B desoxycholate (at 0.5 times the recommended human dose) were administered concomitantly with zidovudine for 30 days. If zidovudine is used concomitantly with ABELCET®, renal and hematologic function should be closely monitored.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = ABELCET (AMPHOTERICIN B, DIMYRISTOYLPHOSPHATIDYLCHOLINE, DL- AND DIMYRISTOYLPHOSPHATIDYLGLYCEROL, DL-) INJECTION [SIGMA-TAU PHARMACEUTICALS, INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=5587db37-f21a-4a39-a319-e1077032ced9 | publisher = | date = | accessdate = }}</ref> | '''Zidovudine''': Increased [[myelotoxicity]] and [[nephrotoxicity]] were observed in dogs when either ABELCET® (at doses 0.16 or 0.5 times the recommended human dose) or amphotericin B desoxycholate (at 0.5 times the recommended human dose) were administered concomitantly with [[zidovudine]] for 30 days. If zidovudine is used concomitantly with ABELCET®, renal and hematologic function should be closely monitored.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = ABELCET (AMPHOTERICIN B, DIMYRISTOYLPHOSPHATIDYLCHOLINE, DL- AND DIMYRISTOYLPHOSPHATIDYLGLYCEROL, DL-) INJECTION [SIGMA-TAU PHARMACEUTICALS, INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=5587db37-f21a-4a39-a319-e1077032ced9 | publisher = | date = | accessdate = }}</ref> | ||
==References== | ==References== | ||
Latest revision as of 05:02, 12 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]
Drug Interactions
No formal clinical studies of drug interactions have been conducted with ABELCET®. However, when administered concomitantly, the following drugs are known to interact with amphotericin B; therefore, the following drugs may interact with ABELCET®:
Antineoplastic agents: Concurrent use of antineoplastic agents and amphotericin B may enhance the potential for renal toxicity, bronchospasm, and hypotension. Antineoplastic agents should be given concomitantly with ABELCET® with great caution.
Corticosteroid and corticotropin (ACTH): Concurrent use of corticosteroids and corticotropin (ACTH) with amphotericin B may potentiate hypokalemia which could predispose the patient to cardiac dysfunction. If used concomitantly with ABELCET®, serum electrolytes and cardiac function should be closely monitored.
Cyclosporin A: Data from a prospective study of prophylactic ABELCET® in 22 patients undergoing bone marrow transplantation suggested that concurrent initiation of cyclosporin A and ABELCET® within several days of bone marrow ablation may be associated with increased nephrotoxicity.
Digitalis glycosides: Concurrent use of amphotericin B may induce hypokalemia and may potentiate digitalis toxicity. When administered concomitantly with ABELCET®, serum potassium levels should be closely monitored.
Flucytosine: Concurrent use of flucytosine with amphotericin B-containing preparations may increase the toxicity of flucytosine by possibly increasing its cellular uptake and/or impairing its renal excretion. Flucytosine should be given concomitantly with ABELCET® with caution.
Imidazoles (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.): Antagonism between amphotericin B and imidazole derivatives such as miconazole nd ketoconazole, which inhibit ergosterol synthesis, has been reported in both in vitro and in vivo animal studies. The clinical significance of these findings has not been determined.
Leukocyte transfusions: Acute pulmonary toxicity has been reported in patients receiving intravenous amphotericin B and leukocyte transfusions. Leukocyte transfusions and ABELCET® should not be given concurrently.
Other nephrotoxic medications: Concurrent use of amphotericin B and agents such as aminoglycosides and pentamidine may enhance the potential for drug-induced renal toxicity. Aminoglycosides and pentamidine should be used concomitantly with ABELCET® only with great caution. 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 with ABELCET®, serum potassium levels should be closely monitored.
Zidovudine: Increased myelotoxicity and nephrotoxicity were observed in dogs when either ABELCET® (at doses 0.16 or 0.5 times the recommended human dose) or amphotericin B desoxycholate (at 0.5 times the recommended human dose) were administered concomitantly with zidovudine for 30 days. If zidovudine is used concomitantly with ABELCET®, renal and hematologic function should be closely monitored.[1]
References
Adapted from the FDA Package Insert.