Health Centres - AmBisome
How does it work?
AmBisome infusion contains the active ingredient amphotericin, which is a type of medicine called an antifungal. It is used to treat infections caused by fungi and yeasts.
Amphotericin kills fungi and yeasts by interfering with their cell membranes. It works by binding to a substance called ergosterol, which is an essential component of fungal cell membranes. This disrupts the fungal cell membrane, causing holes to appear in it.
The cell membranes of fungi are vital for their survival. They keep unwanted substances from entering the cells and stop the contents of the cells from leaking out. As amphotericin causes holes to appear in the cell membranes, essential constituents of the fungal cells can leak out. This kills the fungi and treats the infection.
Amphotericin is not absorbed into the bloodstream when given by mouth. To treat severe fungal or yeast infections that are affecting the whole body and are potentially life-threatening, amphotericin must be given by a drip into a vein (intravenous infusion). Unfortunately amphotericin given in this way commonly causes side effects.
AmBisome infusion is a lipid-based formulation of amphotericin that is less likely to cause side effects than conventional amphotericin infusion (Fungizone). This means it can be given at higher doses than conventional amphotericin. It is reserved for treating severe invasive fungal infections in people who cannot be given conventional amphotericin, for example because they have kidney problems.
What is it used for?
- Severe fungal infections affecting the body as a whole (systemic infection), for example disseminated candidiasis, aspergillosis, mucormycosis, chronic mycetoma, cryptococcal meningitis (used only in people who cannot be given conventional amphotericin, for example because they have kidney problems).
- Protozoal infection affecting the internal organs (visceral leishmaniasis)
- Infections that are presumed to be caused by fungi in people with low white blood cell counts and a fever, where the fever has failed to respond to broad spectrum antibiotics and appropriate investigations have failed to define a bacterial or viral cause.
Warning!
- When amphotericin is administered into a vein it may rarely cause a severe allergic reaction (anaphylaxis). For this reason, it is recommended that a small test dose is given before the first infusion. The patient should be carefully observed for signs of an allergic reaction for about 30 minutes after the test dose.
- During treatment with this medicine you should have regular blood tests to monitor your kidney function, liver function, levels of blood cells and levels of electrolytes (salts such as potassium and magnesium) in your blood. This is particularly important if you already have any problems with your kidneys.
Use with caution in
- Decreased kidney function
- Decreased liver function
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine is not known to be harmful when used during pregnancy. However, the manufacturer states that it should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus. For life-threatening disease, the benefit of treatment is likely to outweigh any risks. Seek medical advice from your doctor.
- There is no information available regarding the safety of this medicine during breastfeeding. Seek medical advice from your doctor.
Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Chills
- Fever (pyrexia)
- Nausea and vomiting
- Low blood potassium level (hypokalaemia)
- Decreased sodium, magnesium or calcium in the blood
- Headache
- Increased heart rate
- Flushing
- Low blood pressure (hypotension)
- Shortness of breath
- Diarrhoea
- Abdominal pain
- Rash
- Back pain
- Chest pain
- Decreased kidney function
- Decreased numbers of platelets in the blood (thrombocytopenia)
- Abnormal liver function tests
- An extreme allergic reaction (anaphylaxis)
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines during treatment this one, to ensure that the combination is safe.
There may be an increased risk of side effects on the kidneys if this medicine is used in combination with other medicines that can have side effects on the kidneys. Some of these are listed below. People receiving treatment with any of these in combination with amphotericin should have their kidney function regularly monitored:
- aminoglycoside antibiotics, eg gentamicin
- ciclosporin
- tacrolimus
- pentamidine
- polymixin
- vancomycin
- zidovudine (there may also be an increased risk of side effects on the blood cells if amphotericin is used with zidovudine. Blood counts and kidney function should be monitored in people on this combination.)
There may be an increased risk of a drop in the amount of potassium in the blood (hypokalaemia) if this medicine is used in combination with any of the following:
- corticosteroids, eg hydrocortisone, fludrocortisone, prednisolone, dexamethasone
- corticotropin (ACTH)
- diuretics, eg bendroflumethiazide, furosemide.
If hypokalaemia occurs due to amphotericin treatment, this may increase the risk of side effects from digoxin.
Amphotericin may increase the blood level of flucytosine, which could increase the risk of its side effects.
Amphotericin may be less effective at treating infection if it is used in combination with azole-type antifungals such as fluconazole, ketoconazole, itraconazole or miconazole.
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