Unknown to a large number of individuals, fungal infections are broadly classified into two different categories – local and systemic. Local infections refer to the occurrence of fungal infections on the skin, mouth and vagina and may infect individuals who are either healthy or immunocompromised. Systemic fungal infections occur in the skin and various vital organs such as the brain, the eyes, the liver and the lungs, and may infect individuals belonging to the immunocompromised category. Amphotericin b belongs to the category of medications prescribed for treatment of serious systemic fungal infections. The following sub-sections offer detailed information about the medication, including possible amphotericin b side effects to help patients prevent or cope with the undesirable outcomes.

Overview of the medication

The prescription only medication is available in powder form and is injected in the veins to treat various fungal infections. This is because of the potent activity of the medication against multiple species of fungi including the following:

  • Histoplasma capsulatum
  • Coccidioides immitis
  • Candida species
  • Blastomyces dermatitidis
  • Rhodotorula
  • Cryptococcus neoformans
  • Sporothrix schenckii
  • Mucor mucedo
  • Aspergillus fumigatus

The medication is used in treating conditions such as cryptococcal meningitis in patients diagnosed with HIV, various fungal infections, including infections in patients with lesser neutrophils. Depending on the strength of the administered powder, the medication is classified as either fungistatic or fungicidal.

The medication, as mentioned above is administered as an injection, directly into the vein, and is typically recommended once a day. Depending on the condition, it may also be administered on alternate days. The injection is to be administered slowly and is depending on the strength, may require anywhere between 2 to 6 hours. As a result of the potent nature of the medication and to avoid the possibility of toxic effects, doctors generally administer a small test does to check the individual’s response to the injection. The actual dosage is determined by various factors such as the overall health of the patient, the weight, and the medical condition being treated, apart from other medications in use.

It is important to note that the initial doses are always lower, and gradually increased. This also applies to instances wherein the patient discontinues the medication for a duration in excess of one week. In other words, if the medication has been taken for some time and stopped for a week or more, then the next dosage when recommencing will always be smaller doses that are gradually increased. As it is recommended for treating systemic fungal infections, the duration of the treatment with the drug may often take as long as months for the infection to be controlled. In certain instances, it may require to be administered for a few weeks before results are experienced.

Mechanism of action of amphotericin b

The outcomes of the medication are attributed to the mechanism of action of the medication which is essentially the binding action with the sterols in the cell membrane. When this binding action occurs in the fungi, a transmembrane channel is created and this modification induces or facilitates the leakage of various intracellular matter. This disruption in the membrane brings about eventual death of the targeted cells, thereby helping treat or manage the infections.

Commonly reported amphotericin b side effects

Without exception all medications come with the possibility of side effects. The effects may be experienced differently by different users; for instance, some may experience mild or moderate effects, while others may experience stronger effects. The intensity and the duration of effects depend on various factors, such as the age, the health and the response to ingredients or mechanism of action of the medication. Certain individuals are also known to be free from all undesirable effects whatsoever. It is therefore wrong to assume that the mere mention of side effects will mean adverse outcomes for all users of the medication. Here is a look at the commonly reported and documented effects of the drug.

Patients administered intravenous injections of amphotericin b are likely to experience fever with possible chills initially. There is also the likelihood of patients experiencing throbbing headache when on the medication. The urge to urinate may either increase or decrease in patients, apart from changes in the rate or pace of heartbeat. Other effects include unusual muscle cramps and possible pain, despite inaction. The possibility of feelings of nausea are also high. One of the most common or frequently reported effects include pain at the site of injection. The patient may experience fatigue that is not attributed to any other reason. Similarly, the individual may also have to put up with possible vomiting sensations.

Undesirable effects that are rare in occurrence

There are certain effects that are rare in occurrence but are also known to be of concern due to the stronger nature of effects. For instance, the patient may experience blurred vision, that may impact routines. Double vision and blurred vision are possibilities that a reason for worry as this may lead to other unfortunate incidents, depending on the circumstances and the actions of the patient. There is the possibility of the patient experiencing seizures when on the drug, apart from certain abnormal sensations – numb feelings, tingling sensations, and some kind of weakness or pain in the limbs.

Undesirable effects belonging to the category of serious effects include difficulty in breathing, shortness of breath, or a tightening feeling in the chest. The patient may experience wheezing and this needs to be handled at a healthcare facility, to prevent it from aggravating to serious conditions. There are other discernible effects that clearly indicate side effects. For instance, the patient may observe the outbreak of rashes on the skin or may experience some kind of itching sensations. There could be unusual bleeding or the patient may end up getting bruised easily.

Unwanted outcomes when injected in the spine

Amphotericin b is also injected in the spine, and this also triggers side effects. It is necessary to identify these side effects and take appropriate remedial and curative measures to alleviate or mitigate the effects. For instance, the patient may experience a sudden change in vision or may end up with blurred vision. There could be difficulty while urinating, apart from certain effects that are common to intravenous injections – like overall fatigue and numb sensations.

Certain effects may not actually need to be treated, as they are likely to resolve naturally after the initial period of mild or moderate effects. Only those effects that are serious in nature or persistent require to be treated. Effects that have an impact on breathing, heart beat rate, and allergies are all effects that need to be treated at the earliest.

Amphotericin b side effects that are relatively common and not serious in nature

The following compilation is of effects that are common in mature and do not require any kind of medical intervention usually. Diarrhea is a possible outcome of the medication, and may resolve naturally after the body adjusts to the drug. However, if it persists or if diarrhea causes extreme fatigue and dehydration, medical intervention is necessary. Similarly, patients may experience indigestion, and sudden loss of appetite when on the medication. Other commonly experienced effects include nausea and vomiting, apart from pain in the stomach. There are certain effects that are not frequent in occurrence or common, but of a mild or moderate type that may not be a cause for concern. For instance, there could be pain in the back, in the legs, or in the neck when on the drug. Similarly, dizzy feelings, a light headed feeling and possible headache may also be experienced by the individual. Vomiting sensations and nausea may also be experienced, but may not be a cause or concern.

Precautions to be taken before commencing treatment with amphotericin b

It is essential to be aware of the possible risks of the drug, and suitable precautions need to be taken before commencing treatment. This includes a history of allergies or allergic reactions to the medication. Individuals who have a history of reactions to certain substances such as specific food products, preservatives, dyes, pollen and dander are expected to check out the ingredients before commencing treatment. This essentially needs to be standard practice and should not be restricted to this medication alone. The medication does not trigger different or additional side effects when used by pediatric patients. It does not have any documented reports of additional adverse effects on children. However, it is to be administered only on specific recommendations of specialists and with continuous monitoring to observe and mitigate any possible adverse outcomes.

However, for geriatric patients, there needs to be extra caution during treatment. While there are no specific studies that report adverse or serious side effects, there is always the age-related effect on medications. The ability of the kidneys and the liver to process drugs is always compromised among the elderly. There is also the possibility of other medications interacting with amphotericin and this makes it essential to take suitable precautions and prevent the possibility of adverse effects.

Impact on pregnant women and nursing mothers

Similar to the effects on young patients and the elderly, there are no documented reports or evidence of the medication impacting pregnant women or breast-feeding women in a different manner or with any additional effects. However, it is also necessary to add that there have been no separate studies conducted to determine the possibility of impact on these categories of users. Hence it is necessary to seek medical assistance and evaluation before treatment.

Possible drug interactions

There is the possibility of drug interactions with other medications. It is therefore necessary to list out clearly all medications in use for all conditions. Most individuals wrongly assume OTC products, herbal products, supplements and alternative therapies to be harmless with no possible interactions. However, this is wrong, as there is every possibility of interactions with medications. Patients on the following medications are to either discontinue one of the two, or with recommendations of the specialist stagger the schedule or modify dosage to lessen the impact of interaction. Medications that are known to interact include arsenic trioxide, bupropion foscarnet, and cyclosporine. It is also important to either avoid or stop alcohol, tobacco and other intoxicants when on the medication.

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