Amphotericin B (Liposomal)

How it works

Amphotericin B binds ergosterol in the fungal cell membrane, forming pores that increase permeability and cause cell death; encapsulation in liposomes alters tissue distribution and lessens host-cell toxicity.

Prescribing in practice

• Lipid and conventional amphotericin formulations are not interchangeable and differ substantially in dosing, so prescriptions must clearly specify the liposomal product to avoid potentially fatal dosing errors.
• Although better tolerated than the conventional form, it still causes dose-related nephrotoxicity and electrolyte disturbances, particularly hypokalaemia and hypomagnesaemia, requiring monitoring and replacement.
• Infusion-related reactions such as fever, rigors and chills can occur and may require supportive measures or rate adjustment.

Monitoring

Monitor renal function, serum potassium and magnesium, and full blood count regularly, and observe for infusion reactions.

Counselling the patient

• Tell staff if you develop fever, chills or shivering during the infusion.
• Regular blood tests are needed to check your kidneys and salts.
• Report muscle weakness or cramps, which may reflect low potassium or magnesium.

Evidence & guidelines

Liposomal amphotericin B is recommended in UK and international guidance for invasive fungal infections and as a first-line option for visceral leishmaniasis, offering reduced nephrotoxicity relative to the conventional formulation.