Overview
Polyene antifungal (gold standard for serious fungal infections). Lipid formulations reduce nephrotoxicity. Treatment of choice for mucormycosis and resistant Candida.
Dosing
Standard: 3-5mg/kg IV q24h Mucormycosis: 5mg/kg q24h Test dose: 1mg over 20min Max dose: 10mg/kg/day
Pharmacokinetics
Onset: Immediate Peak: End infusion Duration: 24hr Metabolism: Unknown Elimination: Biliary Half-life: 15 days
Pharmacodynamics
Mechanism: Binds ergosterol → membrane pores Spectrum: - Broad fungal coverage - Including mucormycosis Resistance: Rare
Clinical Considerations
Clinical Pearls: 1. Premedicate with antipyretics/antihistamines 2. Monitor renal function daily 3. Lipid formulations reduce toxicity 4. Hypokalemia/magnesium wasting 5. Infusion reactions common 6. Avoid normal saline (precipitates) 7. Consider for empiric coverage in neutropenia 8. Store protected from light