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Review

Amphotericin B

No authors listed
In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
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Review

Amphotericin B

No authors listed.
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Excerpt

Amphotericin B is an antifungal agent with a broad spectrum of activity against many fungal species. Amphotericin B commonly causes mild to moderate serum aminotransferase elevations and can cause hyperbilirubinemia, but acute, clinically apparent drug induced liver injury from amphotericin B therapy is exceedingly rare.

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References

    1. Zimmerman HJ. Antifungal agents. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 609-11.(Expert review of hepatotoxicity of antifungal agents published in 1999; “Amphotericin B has rarely been incriminated in hepatic injury”; “The rarity of cases despite widespread use of the drug demonstrates its minimal hepatotoxic threat”).
    1. Moseley RH. Antifungal agents. Antibacterial and antifungal agents. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, p. 470-3. (Review of hepatotoxicity of antifungal agents mentions that amphotericin B rarely causes clinically apparent liver injury but several case reports have been published).
    1. Bennett JE. Antimicrobial agents: antifungal agents. In, Brunton LL, Chabner BA, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill, 2011, pp. 1571-92. (Textbook of pharmacology and therapeutics: amphotericin B is insoluble in water and is formulated for iv use by complexing with bile salts or lipids; binds ergosterol in fungal membrane and increases permeability).
    1. Carnecchia B, Kurtzke J. Fatal toxic reaction to amphotericin B in cryptococcal meningo-encephalitis. Ann Intern Med 1960; 53: 1027-36. (32 year old man with cryptococcal meningitis and complicated course developed nausea and low grade fever with renal insufficiency and severe phlebitis with each of 4 courses of iv amphotericin [60 to 80 mg/day] developing high fever, large tender liver and pneumonia [bilirubin 1.4 mg/dL, Alk P normal], autopsy showing centrolobular fat, but no inflammation and “some degree of hepatic failure”). - PubMed
    1. Miller M. Reversible hepatotoxicity related to amphotericin B. Can Med Assoc J 1984; 131: 1245-7. (51 year old man with acute leukemia developed abnormal ALT [950 U/L], Alk P [150 U/L] and bilirubin [1.6 mg/dL] levels 18 days after starting amphotericin B for pulmonary aspergillosis; asymptomatic and improved on stopping with rapid increase in ALT [100→300 U/L] after 2 day rechallenge). - PMC - PubMed

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