Aminoglycoside
Severe
Textbook
Increased risk of nephrotoxicity.
Avoid concurrent use.
Source: KDT 7e · p746
Drug reference
Amphotericin B
Polyene antifungal · Antifungal
Also known as Amphotericin B deoxycholate, Liposomal Amphotericin B, Amphotericin B lipid complex, Ambisome, Abelcet, Amphotec
START
Liposomal 3–5 mg/kg/day IV (preferred); pre-hydrate, replete K/Mg
TYPICAL MAX
Up to 10 mg/kg/day liposomal (mucormycosis)
STOP IF
Progressive AKI not responsive to hydration, severe infusion/anaphylactic reaction
WATCH
Daily renal function + K/Mg, infusion reactions, LFTs; avoid concurrent nephrotoxins
CDSCO approvedHATC J02AA01
KDIGO 2024 + manufacturer label
- ONSET
- 1h · infusion
- PEAK
- 2h · end of infusion
- t½
- 5d · terminal (tissue-bound, illustrative)
- DURATION
- 1d · once-daily
EXCRETION
Slow renal + biliary, largely unchanged
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Use for life-threatening systemic mycoses — generally considered acceptable when needed (drug of choice in pregnancy for many systemic fungals)
FDA category + note
Top interactionssee all 12 →
- AminoglycosideSevereTextbookKDT 7e · p746
- AminoglycosidesSevereDatabaseKimi deep-research + Cla
- AmiodaroneSevereDatabaseDDInter
- Arsenic TrioxideSevereDatabaseDDInter
Available in India
41 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Binds ergosterol in fungal membranes forming pores → ion leakage and cell death; oxidative damage contributes. Lipid formulations reduce binding to mammalian cholesterol → less nephrotoxicity.
Indications
Severe systemic mycoses (invasive candidiasis/aspergillosis, cryptococcal meningitis, mucormycosis, histoplasmosis, blastomycosis)Visceral leishmaniasis (liposomal)Empirical antifungal in persistent febrile neutropenia
Dosing
- Adult
- Liposomal (AmBisome) 3–5 mg/kg/day IV (up to 10 mg/kg mucormycosis). Conventional deoxycholate 0.5–1 mg/kg/day (rarely used now — higher toxicity). Lipid complex 5 mg/kg/day.
- Pediatric
- Weight-based as adult (formulation-specific).
- Renal adjustment
- Nephrotoxic — prefer lipid formulation; reduce/interrupt with rising creatinine; hydrate and replete K/Mg.
- Hepatic adjustment
- No specific adjustment; monitor LFTs.
- Geriatric
- Higher nephrotoxicity; lipid formulation, monitor.
- Max dose
- Up to 10 mg/kg/day liposomal (mucormycosis); deoxycholate generally ≤1.5 mg/kg/day
Pharmacokinetics
Onset
IV; antifungal over days
Peak effect
End of infusion
Duration
Once-daily; very long tissue retention
Half-life
Terminal weeks (tissue-bound); formulation-dependent
Bioavailability
Negligible oral; 100% IV
Protein binding
>90%
Metabolism
Minimal; not hepatically metabolised
Excretion
Slow renal and biliary (largely unchanged, prolonged)
Contraindications
- Hypersensitivity to amphotericin B (unless infection life-threatening and no alternative)
Side effects
Common
Infusion reactions (fever, rigors, hypotension)Nephrotoxicity (azotaemia, tubular damage)Hypokalaemia, hypomagnesaemiaAnaemia (normochromic)Phlebitis
Serious
- Acute kidney injury (esp. deoxycholate)
- Severe electrolyte disturbance → arrhythmia
- Anaphylaxis/severe infusion reaction
- Cardiotoxicity (rapid infusion); hepatotoxicity
Pregnancy & lactation
Pregnancy
Use for life-threatening systemic mycoses — generally considered acceptable when needed (drug of choice in pregnancy for many systemic fungals)
Lactation
Limited data; minimal oral infant absorption — caution
Drug interactions
Aminoglycosides
Severe
Database
Additive nephrotoxicity
Avoid; if essential, intensive renal monitoring
Source: Kimi deep-research + Cla
Amiodarone
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Arsenic Trioxide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Ciclosporin
Severe
Database
Additive nephrotoxicity
Monitor renal function and CNI levels
Source: Kimi deep-research + Cla
Cidofovir
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Deferasirox
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Diatrizoate
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Digoxin
Severe
Database
Amphotericin hypokalaemia potentiates digoxin toxicity
Monitor K+ and digoxin; replete potassium
Source: Kimi deep-research + Cla
Dofetilide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Dronedarone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Droperidol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about Amphotericin B
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19