Adverse effects amphotericin

A. Infusion related—Adverse effects related to intravenous infusion commonly include fever, chills, muscle spasms, vomiting, and a shock-like fall in blood pressure. These effects may be attenuated by a slow infusion rate and by premedication with antihistamines, antipyretics, meperidine, or glucocorticoids. b. Dose limiting—Amphotericin B decreases the glomerular filtration rate and causes renal tubular acidosis with magnesium and potassium wasting. the nephrotoxic effects of the drug are dose-limiting. Dose reduction (with lowered toxicity) is possible in some infections when amphotericin B is used with flucytosine. Liposomal formulations of amphotericin B have reduced nephrotoxic effects, possibly because of decreased binding of the drug to renal cells. Amphotericin B has a low therapeutic index. The total adult daily dose should not exceed 1.5 mg/kg. Small test doses may be administered to assess the degree of negative responses, such as anaphylaxis or convulsions. A bolus infusion of normal saline before and after amphotericin B infusion may reduce the incidence of drug-induced nephrotoxicity. Azotemia (elevated blood urea) is exacerbated by other nephrotoxic drugs, such as aminoglycosides, cyclosporine, and pentamidine, although adequate hydration can decrease its severity. Hypotension: A shock-like fall in blood pressure accompanied by hypokalemia may occur, requiring potassium supplementation. Care must be exercised in patients taking digoxin. Normochromic, normocytic anemia caused by a reversible suppression of erythrocyte production may occur. This may be exacerbated in patients infected with HIV who are taking zidovudine. Intrathecal administration can cause a variety of serious neurologic problems.seizures Thrombophlebitis: Adding heparin to the infusion can alleviate this problem