AMPHOTEC (Page 4 of 5)

General (body as a whole)

Abdomen enlarged, abdominal pain, back pain, chest pain, face edema, injection site inflammation, mucous membrane disorder, pain, sepsis

Cardiovascular System

Cardiovascular disorder, hemorrhage, postural hypotension

Digestive System

Diarrhea, dry mouth, hematemesis, jaundice, stomatitis

Hemic and Lymphatic System

Anemia, coagulation disorder, prothrombin decreased

Metabolic and Nutritional Disorders

Edema, generalized edema, hypocalcemia, hypophosphatemia, peripheral edema, weight gain

Nervous System

Confusion, dizziness, insomnia, somnolence, thinking abnormal, tremor

Respiratory System

Apnea, asthma, cough increased, epistaxis, hyperventilation, lung disorder, rhinitis

Skin and Appendages

Maculopapular rash, pruritis, rash, sweating

Special Senses

Eye hemorrhage

Urogenital

Hematuria

The following adverse events occurred in 1% to less than 5% of AMPHOTEC patients. The causal association between these adverse events and AMPHOTEC is uncertain.

General (body as a whole)

Accidental injury, allergic reaction, asthenia, death, hypothermia, immune system disorder, infection, injection site pain, injection site reaction, neck pain

Cardiovascular System

Arrhythmia, atrial fibrillation, bradycardia, congestive heart failure, heart arrest, phlebitis, shock, supraventricular tachycardia, syncope, vasodilatation, venoocclusive liver disease, ventricular extrasystoles

Digestive System

Anorexia, bloody diarrhea, constipation, dyspepsia, fecal incontinence, gamma glutamyl transpeptidase increased, gastrointestinal disorder, gastrointestinal hemorrhage, gingivitis, glossitis, hepatic failure, melena, mouth ulceration, oral moniliasis, rectal disorder

Hemic and Lymphatic System

Ecchymosis, fibrinogen increased, hypochromic anemia, leukocytosis, leukopenia, petechia, thromboplastin decreased

Metabolic and Nutritional Disorders

Acidosis, BUN increased, dehydration, hyponatremia, hyperkalemia, hyperlipemia, hypernatremia, hypervolemia, hypoglycemia, hypoproteinemia, lactic dehydrogenase increased, AST (SGOT) increased, ALT (SGPT) increased, weight loss

Musculoskeletal System

Arthralgia, myalgia

Nervous System

Agitation, anxiety, convulsion, depression, hallucinations, hypertonia, nervousness, neuropathy, paresthesia, psychosis, speech disorder, stupor

Respiratory System

Hemoptysis, lung edema, pharyngitis, pleural effusion, respiratory disorder, sinusitis

Skin and Appendages

Acne, alopecia, petechial rash, skin discoloration, skin disorder, skin nodule, skin ulcer, urticaria, vesiculobullous rash

Special Senses

Amblyopia, deafness, ear disorder, tinnitus

Urogenital System

Albuminuria, dysuria, glycosuria, kidney failure, oliguria, urinary incontinence, urinary retention, urinary tract disorder

OVERDOSAGE

AMPHOTEC is not dialyzable. Amphotericin B deoxycholate overdose has been reported to result in cardio-respiratory arrest.

DOSAGE AND ADMINISTRATION

The recommended dose for adults and pediatric patients is 3 — 4 mg/kg as required, once a day.

AMPHOTEC, reconstituted in Sterile Water for Injection, is administered diluted in 5% Dextrose for Injection by intravenous infusion at a rate of 1 mg/kg/hour. A test dose immediately preceding the first dose is advisable when commencing all new courses of treatment. A small amount of drug (e.g., 10 mL of the final preparation containing between 1.6 to 8.3 mg) should be infused over 15 to 30 minutes and the patient carefully observed for the next 30 minutes.

The infusion time may be shortened to a minimum of 2 hours for patients who show no evidence of intolerance or infusion-related reactions. If the patient experiences acute reactions or cannot tolerate the infusion volume, the infusion time may be extended.

Directions for reconstitution and preparation of infusion admixture

AMPHOTEC must be reconstituted by addition of Sterile Water for Injection. Using sterile syringe and a 20-gauge needle, rapidly add the following volumes to the vial to provide a liquid containing 5 mg of amphotericin B per mL. Shake gently by hand, rotating the vial until all solids have dissolved. Note that the fluid may be opalescent or clear.

50 mg/vial add 10 mL Sterile Water for Injection
100 mg/vial add 20 mL Sterile Water for Injection

For infusion, further dilute the reconstituted liquid to a final concentration of approximately 0.6 mg/mL (range 0.16 mg/mL to 0.83 mg/mL). The following table provides dilution recommendations:

Dose ofAMPHOTEC Volume of ReconstitutedAMPHOTEC Infusion Bag Size for5% Dextrose for Injection
10 – 35 mg 2 – 7 mL 50 mL
35 – 70 mg 7 – 14 mL 100 mL
70 – 175 mg 14 – 35 mL 250 mL
175 – 350 mg 35 – 70 mL 500 mL
350 – 1000 mg 70 – 200 mL 1000 mL

Do not reconstitute the lyophilized powder with saline or dextrose solutions, or admix the reconstituted liquid with saline or electrolytes.

The use of any solution other than those recommended, or the presence of a bacteriostatic agent (e.g., benzyl alcohol) in the solution may cause precipitation of AMPHOTEC. Do not filter or use an in-line filter with AMPHOTEC.

Do not mix the infusion admixture with other drugs. If administered through an existing intravenous line, flush with 5% Dextrose for Injection prior to, and following, infusion of AMPHOTEC, otherwise administer via a separate line.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Do not use if a precipitate or foreign matter is present, or if the seal is not intact. Strict aseptic technique always should be observed during reconstitution and dilution since no preservatives are present in the lyophilized drug or in the solutions used for reconstitution and dilution.

After reconstitution, the drug should be refrigerated at 2-8°C (36-46°F) and used within 24 hours. Do not freeze. After further dilution with 5% Dextrose for Injection, the infusion should be stored in a refrigerator (2-8°C) and used within 24 hours. Partially used vials should be discarded.

HOW SUPPLIED

AMPHOTEC® (Amphotericin B) Cholesteryl Sulfate Complex for Injection is a sterile lyophilized powder supplied in single use glass vials. Each vial is individually packaged.

AMPHOTEC 50 mg in 20 mL vial (NDC 64116-025-01)

AMPHOTEC 100 mg in 50 mL vial (NDC 64116-021-01)

STORAGE

Store unopened vials of AMPHOTEC at 15-30°C (59-86°F).

AMPHOTEC should be retained in the carton until time of use.

Manufactured by:
Ben Venue Laboratories, Inc., Bedford, OH 44146, USA

Distributed by:
InterMune, Inc., Brisbane, CA 94005

U.S. Patent Numbers 4,822,777; 5,032,582; 5,194,266; 5,077,057.

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