amphotericin B liposomal (LAmB)

Visceral leishmaniasis Adult and child \geq 1 mo: IV 3 mg/kg every 24 hr days 1-5, and days 14, 21 (immunocompetent), 4 mg/kg every 24 hr days 1-5, and days 10, 17, 24, 31, 38 (immunocompromised) Cryptococcal meningitis in HIV Adult and child \geq 1 mo: IV 6 mg/kg/day Fungal infection, empirical Adult and child \geq 1 mo: IV 3 mg/kg/day Fungal infection, systemic Adult and child \geq 1 mo: IV 3- 5 mg/kg/day

Available forms: Powder for inj 50- mg vial

Implementation Do not confuse four different types; these are not interchangeable: conventional amphotericin B, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome May premedicate with acetaminophen, diphenhydrAMINE

IV route: Give only after C&S confirms organism, product needed to treat condition; make sure product is used for life- threatening infections Administer by IV infusion only; handle with aseptic technique as LAmB does not contain any preservatives Visually inspect products for particulate matter and discoloration

Reconstitution: LAmB must be reconstituted using sterile water for injection (without a bacteriostatic agent); do not reconstitute with saline or add saline to the reconstituted suspension, do not mix with other drugs; doing so can cause a precipitate to form Reconstitute vials containing 50 mg of LAmB/12 ml of sterile water (4 mg/ml) Immediately after the addition of water, SHAKE THE VIAL VIGOROUSLY for 30 sec; the suspension should be yellow and translucent; visually inspect vial for particulate matter and continue shaking until product is completely dispersed Store suspension for up to 24 hours refrigerated if using sterile water for injection; do not freeze Filtration and dilution: Calculate the amount of reconstituted (4 mg/ml) suspension to be further diluted and withdraw this amount into a sterile syringe Attach the provided 5- micron filter to the syringe; inject the syringe contents through the filter, into the appropriate amount of D_5 W injection; use only one filter per vial The suspension must be diluted with D_5 W injection to a final concentration of 1- 2 mg/ml before administration; for infants and small children, lower concentrations (0.2- 0.5 mg/ml) may be appropriate to provide sufficient volume for infusion Use injection of LAmB within 6 hr of dilution with D_5 W IV

INF: Flush intravenous line with D_5 W injection before infusion; if this cannot be done, then a separate IV line must be used An inline membrane filter may be used provided the mean pore diameter of the filter is not less than 1 micron Administer by IV infusion using a controlled infusion device over a period of approximately 120 min; infusion time may be reduced to approximately 60 min in patients who tolerate the infusion; if discomfort occurs during infusion, the duration of infusion may be increased Acetaminophen and diphenhydrAMINE 30 min before inf to reduce fever, chills, headache Store protected from moisture and light; diluted solution is stable for 24 hr at room temp

Y- site compatibilities: Acyclovir, amifostine, aminophylline, anidulafungin, atropine, azithromycin, bivalirudin, bumetanide, buprenorphine, busulfan, butorphanol, CARBO- platin, carmustine, ceFAZolin, ceFOXitin, ceftozime, ceftRIXone, cefuroxime, cimetidine, clindamycin, cyclophosphamide, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, diphenhydrAMINE, doxacurium, enalaprilat, ePHEDrine, EPINEPHrine, eptifibatide, ertapenem, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fludarabine, fluorouracil, fosfemytoin, furosemide, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, ifosfamide, isoproterenol, ketorolac, levorphanol, lidocaine, linezolid, mesna, methotrexate, methylPREDNISolone, metoprolol, milrinone, mitoMYcin, nesiritide, nitroglycerin, nitroprusside, octreotide, oxaliplatin, oxytocin, palonosetron, pancuronium, pantoprazole, PEMEtrexed, PENTobarbital, PHENobarbital, phenylephrine, piperacillin/tazobactam, potassium chloride, procainamide, ranitidine, SUFentanil, tacrolimus, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tigecycline, trimethoprim- sulfamethoxazole, vasopressin, vinCRISTine, voriconazole, zidovudine