Most interactions involving amphotericin B have been observed during treatment with conventional formulations. Since lipid formulations appear to be less toxic, it may be anticipated that they will produce fewer serious interactions. Use of nephrotoxic antibacterials, ciclosporin or other nephrotoxic immunosuppressants, or parenteral pentamidine may lead to an increased risk of nephrotoxicity. Amphotericin B should not be given to patients receiving antineoplastics. Diuretics should generally be avoided in patients taking amphotericin B. If a diuretic has to be given then volume and electrolyte depletion should be monitored carefully. The potassium-depleting effect of amphotericin B may enhance the effects of neuromuscular blocking drugs and may increase the toxicity of digitalis glycosides; corticosteroids may enhance the depletion of potassium and their immunosuppressive effects may be detrimental in patients with severe fungal infections. Amphotericin B may increase the toxicity of flucytosine, but the combination is nonetheless used in severe infections for its synergistic activity. Renal excretion of zalcitabine may be reduced by amphotericin B.
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