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Stability of amphotericin B in CAPD fluid
R Janknegt1, A Paulissen, P M Hooymans
1Department of Clinical Pharmacy, Maasland Hospital, Sittard, The Netherlands.
Abstract:
Amphotericin B is the drug of choice in continuous ambulatory peritoneal dialysis (CAPD) associated fungal peritonitis and is usually administered intraperitoneally. The drug is stated to be incompatible with anions. All CAPD fluids contain chloride and lactate anions. Therefore, the physical and chemical compatibility of amphotericin B with dextrose 5%, Dianeal 1.36% CAPD fluid, and Dianeal 1.36% peritoneal effluent was studied at amphotericin B concentrations of 1, 2, and 5 mg/L. Amphotericin B was most stable in Dianeal CAPD fluid. The rate of degradation was concentration dependent in dextrose 5% and peritoneal effluent. The higher the concentration, the lower the rate of degradation. After an incubation of 6 h at 37 degrees C, no significant decomposition was found at all concentrations studied in Dianeal CAPD fluid whereas 12-18% decomposition was found in effluent. No physical incompatibility with any solution was observed.
Insights
Amphotericin B is stable in Dianeal CAPD fluid, crucial for treating fungal peritonitis. Degradation in dextrose and effluent depends on concentration, with higher doses showing less breakdown.
Area of Science:
- Pharmacology
- Nephrology
- Clinical Pharmacy
Background:
- Amphotericin B is the preferred treatment for fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD).
- CAPD fluids contain anions (chloride, lactate) that may cause incompatibility with amphotericin B.
- Understanding amphotericin B stability in CAPD solutions is vital for effective treatment.
Purpose of the Study:
- To evaluate the physical and chemical compatibility of amphotericin B with common CAPD components.
- To determine the stability of amphotericin B in dextrose 5%, Dianeal 1.36% CAPD fluid, and peritoneal effluent.
Main Methods:
- Amphotericin B solutions at 1, 2, and 5 mg/L were prepared.
- Compatibility was assessed in dextrose 5%, Dianeal 1.36% CAPD fluid, and peritoneal effluent.
- Incubation at 37°C for 6 hours followed by analysis of decomposition.
Main Results:
- Amphotericin B demonstrated highest stability in Dianeal 1.36% CAPD fluid across all tested concentrations.
- Degradation rate in dextrose 5% and effluent was concentration-dependent, decreasing with higher amphotericin B concentrations.
- No significant decomposition of amphotericin B was observed in Dianeal CAPD fluid after 6 hours, while 12-18% decomposition occurred in effluent.
Conclusions:
- Dianeal 1.36% CAPD fluid provides a stable medium for amphotericin B administration.
- Concentration influences amphotericin B degradation in dextrose and effluent, necessitating careful dosing.
- No physical incompatibilities were noted, supporting its use in CAPD fungal peritonitis.