AmBisome (Amphotericin B) Liposome – Intravenous

What Is AmBisome?

AmBisome (amphotericin B) liposome is an antifungal drug prescribed to treat fungal infections that have spread through the bloodstream to affect the heart, lung, brain, kidneys, and other organs. This medication interferes with the fungal cell membrane to stop fungi growth.

AmBisome is given through an intravenous (IV) injection into the veins. Due to its potentially severe side effects, it is only prescribed when a fungal or parasitic infection is so severe that few other treatment options are available.

Drug Facts

Generic Name: Amphotericin B liposome

Brand Name: AmBisome

Drug Availability: Prescription

Therapeutic Classification: Antifungal

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Injection

Active Ingredient: Amphotericin B liposome

Dosage Form: Powder for solution

What Is AmBisome Used for?

The Food and Drug Administration (FDA) approved AmBisome to treat severe and potentially life-threatening fungal infections, such as:

People who are severely immunocompromised, such as those with advanced HIV, are at a high risk of opportunistic fungal infections.

AmBisome is also used to treat a parasitic infection known as visceral leishmaniasis. 

Leishmaniasis is a tropical disease spread by the bite of certain sandflies. It can cause severe ulcers of the skin, mouth, and nose. Visceral leishmaniasis occurs when the parasite spreads to internal organs such as the spleen, liver, and bone marrow. If left untreated, visceral leishmaniasis will almost always lead to death.

How to Take AmBisome

AmBisome is given by IV infusion, usually in a hospital but sometimes in a home care setting by a nurse.

Each vial of AmBisome contains 50 milligrams (mg) of amphotericin B in powdered form, reconstituted with sterile water. Once reconstituted, the health provider will insert a needle into a vein in your arm and slowly administer the drug through a controlled IV drip.

The dose is delivered at a slow, steady pace over two hours to reduce the risk of an adverse reaction. As a precaution, the first dose may be administered for 10 minutes and then stopped for 30 minutes. If there is no reaction, the rest of the drug can be administered.

In people who have tolerated a previous dose of AmBisome, the infusion time may be decreased to one hour.

Storage

AmBisome vials are stored by the healthcare provider at room temperature (about 77 degrees Fahrenheit).

Off-Label Uses

AmBisome is sometimes used off-label for other severe systemic fungal infections, including:

  • Blastomycosis
  • Coccidiomycosis
  • Histoplasmosis
  • Mucormycosis

It has also been used to treat amoebic meningoencephalitis, a severe infection caused when one-celled amoebas invade the brain, spinal cord, and meningeal membranes of the central nervous system.

Off-label use means a drug is prescribed for conditions that the FDA has not approved to treat but has demonstrated benefits for.

What Are the Side Effects of AmBisome?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

AmBisome is used with caution when the benefits of treatment outweigh the risks. Side effects are common, some of which can be severe.

Common Side Effects

The list of AmBisome side effects is extensive, ranging in severity from mild to life-threatening. Although AmBisome is well tolerated in some people, many have some form of a side effect.

Common side effects of AmBisome include:

The risk of side effects is mainly dose-dependent, meaning that higher doses translate to a greater risk of side effects.

Premarket studies (performed before the drug is available for sale) suggest that teenagers and children under the age of 16 tend to tolerate AmBisome better than adults.

Severe Side Effects

A potentially life-threatening, whole-body allergy known as anaphylaxis can occur in some people who received AmBisome.  Amphotericin B hypersensitivity occurs within three hours of the infusion, although the most severe reactions often occur within the first 15 minutes of an infusion.

Even so, hypersensitive reactions to AmBisome are considered rare and are more likely to occur with conventional, non-liposomal forms of amphotericin B.

Signs of a severe hypersensitive reaction to amphotericin B include:

  • Severe flu-like symptoms, such as high fever or headache
  • Skin reactions like rashes or hives
  • Gastrointestinal effects such as nausea or vomiting
  • Drowsiness
  • Generalized weakness
  • Shortness of breath, wheezing, or shallow, rapid breathing
  • Dizziness or fainting

In addition to drug hypersensitivity, amphotericin B has been known to cause acute kidney injury in rare instances. Although the risk is highest in people with preexisting kidney disease, amphotericin B has been known to cause harm in those with no history of kidney problems.

Call your healthcare provider immediately if you have serious side effects after using AmBisome. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. These include symptoms of acute kidney failure, such as:

  • Decreased urine output or no urination
  • Shortness of breath
  • Chest pain or pressure
  • Extreme fatigue
  • Nausea or vomiting
  • Swelling of the legs, feet, or ankles
  • Irregular heartbeat
  • Confusion
  • Seizures

Long-Term Side Effects

AmBisome is generally not used on a long-term basis. If used consistently over time, AmBisome can interfere with the production of erythropoietin (EPO), a hormone produced by the kidneys that plays a key role in the synthesis of red blood cells. This, in turn, can lead to a form of anemia called normocytic anemia, which can be relieved with an injection of Epogen (synthetic EPO).

Report Side Effects

AmBisome may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much AmBisome Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For the treatment of infection caused by fungus or protozoa
    • For injection dosage form:
      • Adults and children: 3 to 6 milligrams (mg) per kilogram (1.36 to 2.73 mg per pound) of body weight once a day, injected slowly into a vein. The number of days that you receive this treatment depends on the medical problem for which you are receiving amphotericin B liposomal complex.

Modifications

Your AmBisome dose can change depending on body weight and the condition being treated. 

The dose is not adjusted by age, kidney function, or immune status. The only exception is the use of AmBisome in treating visceral leishmaniasis. Immunocompromised people require a higher dose and longer duration of therapy than immunocompetent people.

People with kidney disease may need to undergo kidney function tests before, during, and after treatment.

Overdose: What Happens If I Take Too Much AmBisome?

There is limited information about the risk of an AmBisome overdose, given that a healthcare provider administers the drug in a controlled setting.

According to the manufacturer, there have been no reports of dose-related toxicity in clinical studies involving children given daily doses of up to 10 milligrams per kilogram (mg/kg) per day or adults given daily doses of up to 15 mg/kg per day.

What Happens If I Overdose on AmBisome?

If you think you or someone else may have overdosed on AmBisome, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking AmBisome, call 911 immediately.

What Are Reasons I Shouldn’t Take AmBisome?

People who have had a hypersensitive reaction to amphotericin B or any of the other components of the drug should not be given AmBisome unless the benefits of treatment outweigh the risks.

Nonhuman animal studies have not shown any risk of fetal harm when AmBisome is used during pregnancy but no well-controlled studies in humans are available. Careful consultation is needed to weigh the benefits and risks of treatment if you are pregnant or breastfeeding.

What Other Medications Interact With AmBisome?

A significant number of drugs are known to interact with AmBisome. The interactions don’t necessarily contraindicate the use of accompanying drugs, but intensive monitoring of kidney function is recommended.

Let your healthcare provider know if you take any of the following:

A wide range of nephrotoxic drugs can increase the risk of kidney side effects when taken with AmBisome. Nephrotoxic drugs are medications that can cause damage to the kidneys. Other drugs can interact with AmBisome for different reasons, either by causing toxicities that affect the heart or lungs or reducing the effectiveness of amphotericin B. 

Other drugs that interact with AmBisome include:

This is not a complete drug interaction list for AmBisome. Other interactions may occur. To avoid interactions, let your healthcare provider know if you take any prescription, over-the-counter (OTC), herbal, nutritional, or recreational drugs.

What Medications Are Similar?

In addition to AmBisome, there are three other forms of amphotericin B used in the treatment of severe fungal infections:

  • Amphotericin B conjugated with deoxycholate
  • Amphotericin B colloid dispersion
  • Abelcet (amphotericin B lipid complex)

While amphotericin B conjugated with deoxycholate—often referred to as conventional amphotericin B—is highly effective in treating invasive fungal infections (particularly of the brain), the risk of acute kidney injury offsets the benefits. The risk can be reduced somewhat with colloidal dispersion formulations that require a lower dose. The risk of kidney injury is even lower with amphotericin B lipid complex.

Frequently Asked Questions

  • What is AmBisome used for?

    AmBisome (amphotericin B) liposome is a powerful antifungal drug used to treat serious fungal infections of the brain, heart, lungs, and other organs. It can also be used to treat visceral leishmaniasis, an invasive form of a tropical parasitic disease.

  • How does AmBisome work?

    AmBisome works by binding to a substance on the surface of fungi, called ergosterol, that helps maintain the integrity of the cell wall. By doing so, AmBisome can disrupt the function of ergosterol, causing the cell wall to collapse.

  • What are the possible side effects of AmBisome?

    AmBisome is associated with potentially severe side effects and is only used when the benefits outweigh the risks. Potential severe effects include a spike in blood pressure that typically develop within three hours of an infusion, causing high fever, violent chills, breathing problems, nausea or vomiting, shock, and even death.

  • Why should I not be given AmBisome?

    Because invasive fungal infections affect people who are already seriously ill, there are few situations in which AmBisome is avoided other than a known severe allergy to amphotericin B. Given that invasive fungal infections are associated with a high risk of death, the benefits of drugs like AmBisome will typically outweigh the risks if used as directed.

How Can I Stay Healthy While Taking AmBisome?

Invasive fungal infections are usually the consequence of an underlying medical condition that affects how the immune system works. Without a properly working immune system, fungi that normally inhabit the body can suddenly overgrow and invade tissues throughout the body.

When an infection becomes invasive, only aggressive interventions like amphotericin B can bring it under control. At the same time, your healthcare provider will want to address the underlying condition that has compromised the immune system in the first place.

For example, if you have HIV, taking antiretroviral therapy can help suppress the virus to undetectable levels and allow your immune system to rebuild itself. Even people with life-threatening HIV-associated infections can fully recover and thrive when placed on lifelong antiretroviral drugs.

Other interventions may be needed for those with other forms of immune suppression, including organ and stem cell transplant recipients. This may include vaccination, prophylactic drugs to reduce the risk of infection, and preventive practices like handwashing, improved food hygiene, and avoiding respiratory infections.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s) IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.