Amphotericin B Formulations: A Comparative Review of Efficacy and Toxicity

@article{Hamill2013AmphotericinBF,
  title={Amphotericin B Formulations: A Comparative Review of Efficacy and Toxicity},
  author={Richard J. Hamill},
  journal={Drugs},
  year={2013},
  volume={73},
  pages={919-934}
}
Because of the increasing prevalence and changing microbiological spectrum of invasive fungal infections, some form of amphotericin B still provides the most reliable and broad spectrum therapeutic alternative. However, the use of amphotericin B deoxycholate is accompanied by dose-limited toxicities, most importantly, infusion-related reactions and nephrotoxicity. In an attempt to improve the therapeutic index of amphotericin B, three lipid-associated formulations were developed, including… 
Lipid Systems for the Delivery of Amphotericin B in Antifungal Therapy
TLDR
Recent advances in lipid-based systems for targeted delivery of AmB are summarized focusing on non-parenteral nanoparticulate formulations mainly investigated over the last five years and highlighting those that are currently in clinical trials.
Amphotericin B: A review on different formulAtions, side effects, And toxicity
TLDR
Clear and more precise information is needed to an adequate evaluation about pharmacoeconomic aspects of AmB treatment and cost-effectiveness of lipid formulations, focusing on pharmacological properties and toxicity.
Liposomal Amphotericin B (AmBisome®): A Review of the Pharmacokinetics, Pharmacodynamics, Clinical Experience and Future Directions
TLDR
LAmB is a formulation that results in reduced toxicity as compared with DAmB while retaining the antifungal effect of the active agent, and its long terminal half-life and retention in tissues suggest that single or intermittent dosing regimens are feasible.
Amphotericin B: How Much Is Enough?
TLDR
Although available data do not demonstrate significant benefit associated with high-dose therapy, for liposomal amphotericin B, the data also demonstrate no significant harm, and the use of high- doses for salvage therapy may be a consideration.
Comparison of conventional and lipid emulsion formulations of amphotericin B: Pharmacokinetics and toxicokinetics in dogs.
TLDR
Intralipid®, similar to that seen previously in humans, favors AmB distribution to the organs, decreasing drug toxicity and increasing its therapeutic index in the dogs, suggesting that Intralipids 20% (AmB-IL) reduces its toxicity, increases its efficacy and is less expensive than other commercial amphotericin B lipid formulations.
Toxicokinetic and mechanistic basis for the safety and tolerability of liposomal amphotericin B
TLDR
L-AmB is a broad-spectrum antifungal agent that has significantly reduced toxicities compared to its predecessor, DAmB.
Sixty years of Amphotericin B: An Overview of the Main Antifungal Agent Used to Treat Invasive Fungal Infections
TLDR
An overview of the pharmacological properties of the different formulations for systemic use of amphotericin B available for the treatment of invasive fungal infections is presented, highlighting the characteristics related to their chemical, pharmacokinetic structures, drug–target interactions, stability, and others, and points out the most relevant aspects for clinical practice.
Adverse effects of amphotericin B in children; a retrospective comparison of conventional and liposomal formulations
TLDR
When appropriately administered, l-amB was associated with more hepatotoxicity than c-am B, with no difference in infusion-related reactions or nephrotoxicity.
PRECLINICAL TOXICITY STUDY OF THE NEW ANTIFUNGAL DRUG AMPHAMID
Introduction. Amphotericin B remains the drug of first choice in the treatment of most severe systemic fungal infections. However, it is characterized by very low solubility and high toxicity.
[Lipid formulations of amphotericin].
TLDR
A review of amphotericin lipid formulations is presented, focusing on differences in efficacy and, especially renal toxicity, the main problem for use of these formulations in Latin America is their highcost.
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