What is the dosage of Liposomal amphotericin B?

From the Guidelines

The dosage of Liposomal amphotericin B is 3-5 mg/kg daily.

Dosage Details

• The optimal dose of lipid formulations of amphotericin B has not been determined, but a dose of 4-6 mg/kg daily is recommended based on available data 1.
• A study demonstrated that liposomal amphotericin B at a dose of 6 mg/kg daily had an improved outcome over 3 mg/kg daily 1.
• Another study used a mean dose of amphotericin B lipid complex of 4.4 mg/kg daily to treat cryptococcosis 1.
• The ESCMID guideline recommends a dose of 3 mg/kg/day for liposomal amphotericin B for empiric therapy to treat possible Candida disease in adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT) 1.

Key Points

• Liposomal amphotericin B is effective and should be considered for patients who experience renal dysfunction during therapy or have a likelihood of having renal failure 1.
• The dosage of liposomal amphotericin B may vary depending on the specific clinical context and patient population.
• It is essential to consult the latest clinical guidelines and evidence-based recommendations for the use of liposomal amphotericin B in specific clinical scenarios.

From the FDA Drug Label

DOSAGE & ADMINISTRATION VERIFY PRODUCT NAME AND DOSAGE. CAUTION: Under no circumstances should a total daily dose of 1. 5 mg/kg be exceeded. The recommended concentration for intravenous infusion is 0. 1 mg/mL (1mg/10mL). A single intravenous test dose (1 mg in 20 mL of 5% dextrose solution) administered over 20 to 30 minutes may be preferred. In patients with good cardio-renal function and a well tolerated test dose, therapy is usually initiated with a daily dose of 0. 25 mg/kg of body weight. However, in those patients having severe and rapidly progressive fungal infection, therapy may be initiated with a daily dose of 0.3 mg/kg of body weight. Depending on the patient's cardio-renal status, doses may gradually be increased by 5 to 10 mg per day to final daily dosage of 0.5 to 0. 7 mg/kg. Total daily dosage may range up to 1.0 mg/kg per day or up to 1. 5 mg/kg when given on alternate days.

The dosage of Liposomal amphotericin B is not directly stated in the provided drug labels, however, the dosage of amphotericin B for injection is as follows:

• Initial dose: 0.25 mg/kg of body weight per day for patients with good cardio-renal function
• Severe infections: 0.3 mg/kg of body weight per day
• Maximum dose: 1.5 mg/kg per day
• Alternate day dosing: up to 1.5 mg/kg when given on alternate days 2

From the Research

Dosage of Liposomal Amphotericin B

The recommended dosage of liposomal amphotericin B varies across different studies, but the general consensus is as follows:

• The dosage range is between 3 to 6 mg/kg/day 3, 4, 5
• A lower dose of 1mg/kg/day may be equally effective and a lower cost alternative for many indications 3
• The optimal dosing remains unclear, but is generally between 3 and 5 mg/kg/day 4
• A study found that a higher dosage of 10 mg/kg/day did not improve efficacy, but was associated with increased nephrotoxicity 6

Specific Dosage Recommendations

• For empirical therapy in febrile neutropenia, the typical dosage is 3 mg/kg/day 6
• For treatment of confirmed invasive fungal infections, the recommended dosage is 3-6 mg/kg/day 5
• For treatment of disseminated histoplasmosis, the recommended dosage is 3-5 mg/kg/day 6

Key Points

• Liposomal amphotericin B is a safe and efficacious antifungal drug for the treatment of severe invasive fungal infections 7
• The dosage should be adjusted based on the specific indication and patient population 6
• Nephrotoxicity is a potential side effect, but is generally less common with liposomal amphotericin B compared to other amphotericin B formulations 4, 5