Implementation

Do not confuse amphotericin B cholesteryl sulfate (Amphotec) with amphotericin deoxycholate, amphotericin B lipid complex (Abelcet), or amphotericin B liposome (AmBisome); they are not interchangeable

» This drug should be administered IV only to hospitalized patients or those under close supervision. Diagnosis should be confirmed before administration

• Test dose:
Diluent: Reconstitute 50-mg vial with 10 ml of sterile water for injection to achieve a concentration of 5 mg/ml. Reconstituted vial stable for 24 hr at room temperature or 1 wk if refrigerated. Further dilute with 500 ml of D5W. May be diluted in 250 ml of D5W if being administered via a central venous catheter. Protect infusion from light. Infusion stable for 24 hr at room temperature or 2 days if refrigerated. To obtain test dose, withdraw 1 mg (10 ml) from 500 ml infusion and further dilute with D5w to a total volume of 20 ml.
Concentration: 0.05 mg/ml

• Rate:
Infuse over 10–30 min to determine patient tolerance. Pedi: Infuse over 30–60 min

• Intermittent Infusion:
Diluent: Reconstitute and dilute 50-mg vial as per the directions above.
Concentration: Final concentration of infusion should not exceed 0.1 mg/ml for peripheral infusion or 0.25 mg/ml for central line administration

• Rate:
Infuse slowly over 4–6 hr

• Y-Site Compatibility:

» amiodarone

» diltiazem

» hydromorphone

» lorazepam

» tacrolimus

• Y-Site Incompatibility:

» acyclovir

» amikacin

» ampicillin

» ampicillin/sulbactam

» anidulafungin

» atropine

» aztreonam

» bivalirudin

» bumetanide

» calcium chloride

» calcium gluconate

» caspofungin

» cefepime

» ceftizoxime

» chloramphenicol

» cimetidine

» clindamycin

» daptomycin

» dexamethasone sodium phosphate

» diazepam

» digoxin

» diphenhydramine

» dobutamine

» dopamine

» doxycycline

» ertapenem

» erythromycin

» esmolol

» famotidine

» fenoldopam

» filgrastim

» fluconazole

» ganciclovir

» gentamicin

» granisetron

» haloperidol

» hydralazine

» hydrocortisone sodium succinate

» hydroxyzine

» isoproterenol

» ketorolac

» labetalol

» lansoprazole

» levofloxacin

» lidocaine

» linezolid

» meperidine

» meropenem

» methylprednisolone sodium succinate

» metoclopramide

» metoprolol

» metronidazole

» midazolam

» morphine

» nafcillin

» nitroprusside

» norepinephrine

» ondansetron

» palonosetron

» pantoprazole

» penicillin G potassium

» phenylephrine

» phenytoin

» piperacillin/tazobactam

» potassium chloride

» prochlorperazine

» promethazine

» propofol

» propranolol

» protamine

» quinupristin/dalfopristin

» sodium bicarbonate

» tigecycline

» tirofiban

» tobramycin

» trimethoprim/sulfamethoxazole

» vancomycin

» vasopressin

» verapamil

» voriconazole

• Solution Incompatibility:

» LR injection

» saline solutions

• Test Dose:
Diluent: Reconstitute 50-mg vial with 10 ml and 100-mg vial with 20 ml of sterile water for injection to achieve a concentration of 5 mg/ml. Reconstituted vials are stable for 24 hr if refrigerated. Further dilute with D5W to achieve concentration below. Do not use other diluents. Infusion stable for 24 hr if refrigerated. Protect from light. To obtain test dose, withdraw 10 ml from final preparation.
Concentration: Final concentration of infusion should be approximately 0.6 mg/ml (range 0.16–0.83 mg/ml)

• Rate:
Infuse over 15–30 min

• Intermittent Infusion:
Diluent: Prepare infusion according to directions above.
Concentration: Final concentration of infusion should be approximately 0.6 mg/ml (range 0.16–0.83 mg/ml)

• Rate:
Infuse at a rate of 1 mg/kg/hr. If patient tolerates infusion without adverse reactions, infusion time may be shortened to a minimum of 2 hr. If reactions occur or patient cannot tolerate volume, infusion time may be extended. Rapid infusions may cause hypotension, hypokalemia, arrhythmias, and shock

• Y-Site Compatibility:

» acyclovir

» aminophylline

» cefoxitin

» ceftizoxime

» clindamycin

» dexamethasone sodium phosphate

» fentanyl

» furosemide

» ganciclovir

» granisetron

» hydrocortisone

» lorazepam

» methylprednisolone

» nitroglycerin

» trimethoprim/sulfamethoxazole

• Y-Site Incompatibility:

» amikacin

» ampicillin

» ampicillin/sulbactam

» aztreonam

» calcium chloride

» calcium gluconate

» cefazolin

» cefepime

» ceftazidime

» ceftriaxone

» cimetidine

» cisatracurium

» cyclosporine

» diazepam

» digoxin

» diphenhydramine

» dobutamine

» dopamine

» droperidol

» enalaprilat

» esmolol

» famotidine

» fluconazole

» gentamicin

» haloperidol

» heparin

» hydromorphone

» hydroxyzine

» imipenem/cilastatin

» labetalol

» lidocaine

» magnesium sulfate

» meperidine

» metoclopramide

» metoprolol

» metronidazole

» midazolam

» morphine

» ondansetron

» phenytoin

» piperacillin/tazobactam

» potassium chloride

» prochlorperazine

» promethazine

» propranolol

» ranitidine

» sodium bicarbonate

» ticarcillin-clavulanate

» tobramycin

» vancomycin

» vecuronium

» verapamil

• Solution Incompatibility:

» saline solutions

• Intermittent Infusion:
Diluent: Shake vial gently until yellow sediment at bottom has dissolved. Withdraw dose from required number of vials with 18-gauge needle. Replace needle from syringe filled with amphotericin B lipid complex with 5-micron filter needle. Each filter needle may be used to filter the contents of no more than 4 vials. Insert filter needle of syringe into IV bag of D5W and empty contents of syringe into bag. Protect from light. Infusion is stable for 6 hr at room temperature or 48 hr if refrigerated.
Concentration: Final concentration of infusion should be 1 mg/ml; a concentration of 2 mg/ml can be used for pediatric patients or patients who cannot tolerate large volumes of fluid

• Rate:
Do not use an in-line filter. Infuse at a rate of 2.5 mg/kg/hr via infusion pump. If infusion exceeds 2 hr, mix contents by shaking infusion bag every 2 hr. If administering through an existing line, flush line with D5W before infusion or use a separate line

• Y-Site Compatibility:

» anidulafungin

» ertapenem

• Y-Site Incompatibility:

» daptomycin

» tigecycline

» tirofiban

• Solution Incompatibility:

» saline solutions

• Intermittent Infusion:
Diluent: Reconstitute each 50–mg vial with 12 ml of sterile water for injection to achieve concentration of 4 mg/ml. Immediately shake vial vigorously for at least 30 seconds until all particulate matter is completely dispersed. Reconstituted vials are stable for 24 hr if refrigerated. Withdraw appropriate volume for dilution into a syringe. Attach the 5-micron filter to the syringe and inject syringe contents into an appropriate volume of D5W. Infusion should be administered within 6 hr of dilution.
Concentration: Final concentration of infusion should be 1–2 mg/ml; a lower concentration (0.2–0.5 mg/ml) may be used for infants and small children

• Rate:
Infuse over 2 hr. Infusion time may be shortened to 1 hr if patient tolerates infusion without any adverse reactions. If discomfort occurs during infusion, duration of infusion may be increased. May be administered through an in-line filter with pore diameter of at least 1 micron. If administering through an existing line, flush line with D5W before infusion or use a separate line

• Y-Site Compatibility:

» acyclovir

» anidulafungin

» atropine

» azithromycin

» bumetanide

» cefazolin

» cefoxitin

» ceftizoxime

» ceftriaxone

» cefuroxime

» cimetidine

» clindamycin

» daptomycin

» dexamethasone sodium phosphate

» diphenhydramine

» enalaprilat

» epinephrine

» ertapenem

» esmolol

» famotidine

» fenoldopam

» fentanyl

» furosemide

» haloperidol

» heparin

» hydrocortisone sodium succinate

» hydromorphone

» isoproterenol

» ketorolac

» lidocaine

» linezolid

» methylprednisolone sodium succinate

» metoprolol

» milrinone

» nitroglycerin

» nitroprusside

» palonosetron

» pantoprazole

» phenylephrine

» piperacillin/tazobactam

» potassium chloride

» procainamide

» ranitidine

» tacrolimus

» ticarcillin/clavulanate

» trimethoprim/sulfamethoxazole

» voriconazole

• Y-Site Incompatibility:

» amikacin

» ampicillin

» ampicillin/sulbactam

» aztreonam

» calcium chloride

» calcium gluconate

» caspofungin

» cefepime

» cefotaxime

» ceftazidime

» ciprofloxacin

» cyclosporine

» diazepam

» digoxin

» diltiazem

» dobutamine

» dolasetron

» dopamine

» doxycycline

» droperidol

» erythromycin

» gentamicin

» hydroxyzine

» imipenem/cilastatin

» labetalol

» lorazepam

» magnesium sulfate

» meperidine

» meropenem

» metoclopramide

» metronidazole

» midazolam

» morphine

» nicardipine

» ondansetron

» phenytoin

» potassium phosphate

» prochlorperazine

» promethazine

» propranolol

» quinupristin/dalfopristin

» sodium bicarbonate

» tobramycin

» vancomycin

» verapamil

• Solution Incompatibility:
Do not dilute or admix with saline solutions, other medications, or solutions containing a bacteriostatic agent

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