Some patients tolerate injectable full dose amphotericin. However, in the majority there some degree of intolerance, often at lower doses than the full therapeutic. Intolerance can be reduced through the appointment of anti-inflammatory, antihistamine or antiemetic drugs. The clomiphene citrate introduction of amphotericin B in a day can reduce the effects of vomiting and phlebitis. Simultaneous administration of small doses of corticosteroids just prior to or during the infusion of amphotericin B may reduce the reaction temperature. Dosage and duration of such corticosteroid therapy should be minimal. Adding a small amount of heparin in the infusion solution may reduce the frequency of thrombosis and bleeding disorders. When introducing the substance into the cavity of the vessel is not (extravasation) may be chemical irritation to surrounding tissues.
The most frequently observed adverse reactions include: fever (sometimes with attacks of chills), headache, anorexia, weight loss, nausea and vomiting, malaise, pain in muscles and joints, indigestion, spazmoobraznye stomach pain, diarrhea, localized pain in the body injection site, accompanied by the phenomena of phlebitis and thrombophlebitis, normotsitnaya normochromic anemia and hypokalemia. Frequent and impaired renal function, including hypokalemia, azotemia, gipostenuriyu, acidosis and nephrocalcinosis renal tubules. All of these symptoms usually decrease with the cancellation treatment. However, it often remains a degree of permanent kidney damage, especially in patients receiving high amounts .
The following side effects occur less frequently or only rarely: anuria (oliguria), manifestations of toxic effects on the cardiovascular system, including arrhythmia , ventricular fibrillation, cardiac arrest, hypotension, hypertension, coagulation disorders, thrombocytopenia, leukopenia, agranulocytosis, eosinophilia, leukocytosis, blood in the stool or hemorrhagic gastroenteritis, maculopapular rash and itching, loss of hearing, tinnitus, transient dizziness, blurred vision or double vision, peripheral neuropathy, seizures and other neurological symptoms, anaphylactic reaction, acute liver failure and tides.
Bottles with unreduced material should clomiphene citrate be stored in the refrigerator. The concentrate (5 mg / ml after reconstitution with 10 ml of sterile water for injection) should be stored in a dark place. Lack of microbial preservative, and the risk of contamination during recovery is meant that the drug should not be stored for more than 8 hours at room temperature or in a refrigerator for 24 hours after reconstitution. If it is necessary in the case of aseptic application techniques known drug recovery, it can be stored for 24 hours at room temperature or in the refrigerator for a week without loss of chemical stability. The drug is not available in packaging for many doses. Any number of unused material should be discarded. Solutions prepared for intravenous infusion (10 mg or less per 100 ml amphotericin B) should be used immediately after preparation and administered under protection from direct light.
The literature describes different routes of administration for intravenous injection fungizone: Irrigation / instillation into the bladder (if candiduria): 50 continuous irrigation amphotericin mg dissolved in 1 liter of sterile water, every day until negative urine culture results. Also described the use of periodic doses of 100-400 ml (the concentration of 37,5-200 g / ml). Urine should alkalify (with the addition of potassium citrate) and to protect the crotch area of antifungal ointment.
Inhaled amphotericin clomiphene citrate: 8 – 40 mg of amphotericin B in sterile water solution or 5% dextrose, inhaled through nebulyator (fine spray), the total dose is divided several inhalations.Recommended as the simultaneous inhibition of yeast growth lesions in the oral cavity and intestines.
Introduction into the spinal canal (at koktsidioidoznom meningitis):
The literature recommends maintenance doses comprising 0.25-1.0 mg of amphotericin B is 24 times a day, starting with the lower doses (0.025 mg) and gradually increasing them cautiously. When administered into the cerebrospinal fluid amphotericin irritant.
Other routes of administration: fungizone other routes of administration include intravenous injection, local irrigation for treatment of fungal infections of the ear, eye, peritoneum, lung cavities and joints. More detailed information is available upon request.