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Liposomal amphotericin B associated with severe hyperphosphatemia

Scott M Sutherland1, David K Hong, Jay Balagtas

  • 1Division of Pediatric Nephrology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA. suthersm@stanford.edu

The Pediatric Infectious Disease Journal
|December 29, 2007
PubMed

Insights

Four patients experienced hyperphosphatemia during liposomal amphotericin B treatment for fungal infections. Symptoms resolved upon switching to amphotericin B lipid complex, suggesting a potential link in renal insufficiency.

Area of Science:

  • Mycology
  • Nephrology
  • Pharmacology

Background:

  • Invasive fungal infections necessitate potent antifungal therapies.
  • Amphotericin B formulations, including liposomal amphotericin B (L-AMB), are crucial for treating severe mycoses.
  • Renal function is a critical consideration in managing patients on nephrotoxic medications.

Observation:

  • Four patients receiving liposomal amphotericin B (L-AMB) developed hyperphosphatemia.
  • The hyperphosphatemia was observed during treatment for invasive fungal infections.
  • These patients had mild to moderate renal insufficiency.

Findings:

  • Hyperphosphatemia resolved in all four patients after transitioning from L-AMB to amphotericin B lipid complex (ABLC).
  • This suggests a potential adverse effect of L-AMB on phosphate homeostasis.
  • The incidence may be higher in patients with compromised renal function.

Implications:

  • Clinicians should monitor phosphate levels in patients receiving L-AMB, particularly those with renal impairment.
  • Transitioning to ABLC may be a viable strategy to manage L-AMB-induced hyperphosphatemia.
  • Further research is warranted to elucidate the mechanism and prevalence of this adverse effect.

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