Amphotericin B: side effects and toxicity

Laniado-Laborín, Rafael; Cabrales-Vargas, Maria Noemí

doi:10.1016/j.riam.2009.06.003

Cited by 739Antifungal resistance and susceptibilityFungal Infections and StudiesAcute Kidney Injury Research

Amphotericin B: side effects and toxicity

Laniado-Laborín, Rafael, Cabrales-Vargas, Maria Noemí·2009·Revista Iberoamericana de Micología

DOI 10.1016/j.riam.2009.06.003

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Abstract

Amphotericin B (AmB) is a crucial agent in the management of serious systemic fungal infections. In spite of its proven track record, its well-known side effects and toxicity will sometimes require discontinuation of therapy despite a life-threatening systemic fungal infection. The mechanism of action of AmB is based on the binding of the AmB molecule to the fungal cell membrane ergosterol, producing an aggregate that creates a transmembrane channel, allowing the cytoplasmic contents to leak out, leading to cell death. Most of the efforts at improving AmB have been focused on the preparation of AmB with a lipid conjugate. AmB administration is limited by infusion-related toxicity, an effect postulated to result from proinflammatory cytokine production. The principal acute toxicity of AmB deoxycholate includes nausea, vomiting, rigors, fever, hypertension or hypotension, and hypoxia. Its principal chronic adverse effect is nephrotoxicity. AmB probably produces renal injury by a variety of mechanisms. Risk factors for AmB nephrotoxicity include male gender, higher average daily dose of AmB (> or = 35 mg/day), diuretic use, body weight > or = 90 kg, concomitant use of nephrotoxic drugs, and abnormal baseline renal function. Clinical manifestations of AmB nephrotoxicity include renal insufficiency, hypokalemia, hypomagnesemia, metabolic academia, and polyuria due to nephrogenic diabetes insipidus. Human studies show convincingly that sodium loading in excess of the usual dietary intake notably reduces the incidence and severity of AmB-induced nephrotoxicity.

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The main problem associated with the prophylactic use of conventional amphotericin B is its side effects and toxicity.
“However, the main problem associated with the prophylactic use of conventional amphotericin B has always been due to its well-known side effects and toxicity [123, 124].”
From CandidaInfections, Causes, Targets, and Resistance Mechanisms: Traditional and Alternative Antifungal Agents (2013) · cites this paper as [123]

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Authors: Laniado-Laborín, R., & Cabrales-Vargas, M. N.
Affiliations: Universidad Autónoma de Baja California (MX)
Venue: Revista Iberoamericana de Micología
Publisher: Elsevier BV
Published: 2009-10
Volume: 26
Issue: 4
Pages: 223-227
ISSN: 1130-1406 (ISSN-L)
DOI: 10.1016/j.riam.2009.06.003
OpenAlex: W2120177610
Cited by: 739
References: 54
Citations by year: 2026: 42 · 2025: 64 · 2024: 73 · 2023: 69 · 2022: 67 · 2021: 63 · 2020: 60 · 2019: 30 · 2018: 35 · 2017: 44 · 2016: 34 · 2015: 34 · 2014: 35 · 2013: 35 · 2012: 31
FWCI: 2.06
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Revista Iberoamericana de Micología (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords: amphotericin B, amphotericin B deoxycholate, infusion-related toxicity, nephrotoxicity, systemic fungal infection, ergosterol, inflammatory cytokines, hypokalemia, nephrogenic diabetes insipidus, salt loading, drug toxicity
MeSH terms: Amphotericin B, Anemia, Animals, Arrhythmias, Cardiac, Calcium Channel Blockers, Fever, Gastrointestinal Diseases, Humans, Hyperkalemia, Kidney Diseases, Liposomes, Mycoses, Sodium Chloride, Cytokines, Rats

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Amphotericin B: side effects and toxicity

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