Clinical use of liposomal and lipid-complexed amphotericin B

Encapsulation of amphotericin B in liposomes or complexing of the compound with other lipid carriers brings about a major reduction in toxicity. Although animal experimental studies have shown an increased therapeutic index for a variety of such lipid formulations resulting in higher dose-dependent efficacy rates, clinical data on pharmacokinetics and efficacy are still scanty. AmBisomeR, Amphotericin B Lipid Complex (ABLC) and AmphocilR (Amphotericin B Colloidal Dispersion, ABCD) have quite different structural and pharmacokinetic characteristics; however, it is not clear whether these differences are important with respect to tolerance and efficacy. At this moment, most published clinical data are available for AmBisomeR, which shows encouraging results in a variety of invasive fungal infections. AmBisomeR has been safely administered in high dosages up to 5 mg/kg/day. Randomized comparative trials with liposomal and other lipid-complexed amphotericin B formulations versus conventional amphotericin B are urgently needed to assess their respective clinical values.