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Amphotericin B lipid complex

R P Rapp1, P O Gubbins, M E Evans

  • 1College of Pharmacy, University of Kentucky Medical Center, Lexington, USA.

The Annals of Pharmacotherapy
|October 24, 1997
PubMed
Summary
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Amphotericin B lipid complex (ABLC) offers an improved safety profile for treating invasive mycosis compared to conventional amphotericin B deoxycholate (DCAB). While equally effective, ABLC demonstrates reduced nephrotoxicity, though infusion-related toxicities remain similar.

Area of Science:

  • Pharmacology
  • Mycology
  • Clinical Medicine

Background:

  • Conventional amphotericin B deoxycholate (DCAB) is a primary treatment for invasive fungal infections but has a narrow therapeutic index.
  • Infusion-related toxicities (fever, chills) and nephrotoxicity limit DCAB's use.

Purpose of the Study:

  • To review published data on the efficacy and safety of amphotericin B lipid complex (ABLC).
  • To evaluate the pharmacologic properties and pharmacokinetics of ABLC in humans and animals.
  • To compare ABLC with DCAB for invasive mycosis treatment.

Main Methods:

  • A comprehensive literature search of MEDLINE and conference abstracts was performed (1965-1997).
  • Human and animal studies, including in vitro, controlled, open-label, and emergency use protocols, were reviewed.

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  • Pharmacokinetic data for ABLC and DCAB in humans were evaluated.

    • Main Results:

    • ABLC, a lipid formulation, reduces mammalian cell toxicity by altering amphotericin B's affinity and selective transfer.
    • In humans, ABLC increases amphotericin B's volume of distribution, allowing larger doses and longer durations with less nephrotoxicity.
    • Infusion-related toxicities were similar between ABLC and DCAB.

    Conclusions:

    • ABLC is as effective as DCAB for invasive mycosis and is well-tolerated.
    • ABLC exhibits significantly reduced nephrotoxicity, even with high doses and extended use.
    • High cost may restrict ABLC use to refractory cases or when DCAB is contraindicated.