Amphotericin B (Liposomal)

eMC §4.2 (Amphotericin B Gilead liposomal 50 mg powder for dispersion for infusion, previously AmBisome). NON-EQUIVALENCE: different amphotericin products (sodium deoxycholate, liposomal, lipid complex) are NOT equivalent in pharmacodynamics, pharmacokinetics or dosing and must not be used interchangeably; verify the trade name, common name and dose before administration - there is a risk of under-dose if the liposomal product is given at a dose recommended for amphotericin B deoxycholate. Anaphylaxis and anaphylactoid reactions can occur at any point of treatment, so monitor the patient closely during every infusion. INDICATION-SPECIFIC DOSING: treatment of mycoses 3 to 5 mg/kg/day for a minimum of 14 days, adjusted to the specific requirements of each patient. MUCORMYCOSIS - recommended starting dose 5 to 10 mg/kg/day for suspected or confirmed infection; dose at 10 mg/kg/day in patients with brain involvement or solid-organ transplant; avoid slow escalation of doses; duration determined individually, with courses of up to 6-8 weeks commonly used and longer durations sometimes required for deep-seated infection or prolonged chemotherapy/neutropenia. HIV-ASSOCIATED CRYPTOCOCCAL MENINGITIS - a single dose of 10 mg/kg on day 1, in combination with daily flucytosine 100 mg/kg and daily fluconazole 1200 mg, both given for 14 days; after the 2-week induction period, fluconazole 800 mg daily for 8 weeks and then 200 mg daily thereafter at the treating physician's discretion. VISCERAL LEISHMANIASIS - a total dose of 21.0 to 30.0 mg/kg body weight given over 10-21 days; administer under strict medical supervision (data on optimal dosage and development of resistance are incomplete). EMPIRICAL TREATMENT OF FEBRILE NEUTROPENIA - 3 to 5 mg/kg/day, continued until the recorded temperature has been normal for 3 consecutive days; discontinue after a maximum of 42 days in any event. PAEDIATRIC (SPC does not give a separate paediatric number, so no structured paediatric dose is recorded here): both systemic fungal infections and presumed fungal infections in children with febrile neutropenia have been successfully treated, without reports of unusual adverse events; the product has been studied in paediatric patients aged one month to 18 years and the doses used in those studies were the same as those used in adults on a mg/kg body weight basis. NOT recommended in children below 1 month old due to lack of safety and efficacy data. Verify paediatric use against a children's formulary. ELDERLY: no alteration in dose or frequency of dosing is required. HEPATIC IMPAIRMENT: no data are available on which to make a dose recommendation. US labelling (Sun Pharmaceutical, 2026-04-20) differs and quotes initial doses of 3 mg/kg/day for empirical therapy, 3 to 5 mg/kg/day for systemic Aspergillus, Candida or Cryptococcus infection and 6 mg/kg/day for cryptococcal meningitis in HIV-infected patients, with visceral leishmaniasis 3 mg/kg/day on days 1-5 plus days 14 and 21 (immunocompetent) or 4 mg/kg/day on days 1-5 plus days 10, 17, 24, 31 and 38 (immunocompromised), infused over approximately 120 minutes (reducible to about 60 minutes if well tolerated) - use the UK SPC figures above unless local policy states otherwise.