Injectable amphotericin B: mix-ups between lipid and non-lipid formulations

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Patient Safety

Background:

• Amphotericin B is a critical antifungal agent with a narrow therapeutic index.
• It is associated with significant renal and cardiac toxicities.
• Three injectable formulations of Amphotericin B exist, differing primarily in dosage regimens.

Purpose of the Study:

• To highlight the risks of fatal overdoses with Amphotericin B due to formulation confusion.
• To recommend measures for preventing medication errors related to Amphotericin B administration.

Main Methods:

• Review of adverse event reports and available drug formulations.
• Analysis of potential sources of confusion in prescribing and dispensing.
• Identification of best practices for safe administration.

Main Results:

• Fatal overdoses have been reported due to misidentification of Amphotericin B injectable forms.
• Differences in dose regimens among formulations contribute to potential errors.
• Lack of clear communication regarding excipients and dosing can lead to dangerous administration mistakes.

Conclusions:

• Healthcare professionals must be trained to recognize that Amphotericin B formulations are not interchangeable.
• Clear labeling, including excipients and both INN and brand names, is crucial.
• Implementing standardized protocols for dosing, patient involvement, and dose calculation (per kg/day and total daily dose) can mitigate overdose risks.