Treatment of severe systemic fungal infections including aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, mucormycosis, paracoccidioidomycosis, sporotrichosis; fungal endocarditis, meningitis, peritonitis or severe resp tract infections.
Initial test dose: 1 mg IV infusion over 20-30 min. Usual starting dose: 250 mcg/kg, increased gradually to a max of 1 mg/kg daily. Seriously ill patient Up to 1.5 mg/kg daily or on alternate days. If treatment is stopped >7 days, resumed at 250 mcg/kg & increased gradually. Daily dose infused over 2-4 hr at conc of 100 mcg/mL in glucose 5%. Slower infusion, over up to 6 hr to reduce acute toxic effects.
Prophylactic treatment should be given to patients w/ acute toxic reactions. Slow IV infusion to reduce risk of vein irritation & infusion-related effects. Interrupt therapy or reduce dose if BUN or creatinine conc increases to clinically significant levels. Severe systemic reaction can occur w/ rapid IV infusion; potentially nephrotoxic & may aggravate renal insufficiency especially in dehydrated state. Monitor kidney & liver function, serum electrolytes & hematological status. Discontinue use in abnormal liver function tests. Take care not to confuse the dosage regimens for individual prep & in those of conventional & lipid formulations.
Antineoplastics. Increased risk of nephrotoxicity w/ nephrotoxic antibacterials or immunosuppressants, ciclosporin & parenteral pentamidine. Do not give to patients receiving antineoplastics. Hypokalemia & hypomagnesemia w/ diuretics. Enhanced effects of neuromuscular blockers. Corticosteroids may enhance K depletion & their immunosuppressive effects may be detrimental in patients w/ severe fungal infections. Increased toxicity of digitalis glycosides & flucytosine. Reduced renal excretion of zalcitabine.
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