Polyenes
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Amphotericin B Dosage

Drug Detail:Amphotericin b (Amphotericin b [ am-foe-ter-i-sin ])

Drug Class: Polyenes

Contents
Uses Warnings Before Taking Dosage Side effects Interactions

Usual Adult Dose for Ocular Fungal Infection

5 to 10 micrograms INTRAVITREALLY

  • Use with systemic voriconazole.


Comments:
  • Local drug concentration is lower if injected at the end of a pars plana vitrectomy, reducing retinal toxicity concerns.

Use(s): Aspergillus endophthalmitis

Usual Adult Dose for Aspergillosis - Invasive

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to a final daily dose of 0.5 to 0.7 mg/kg IV once a day depending on cardio-renal status.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Cumulative dose: Up to 3.6 grams
Duration of therapy: Up to 11 months

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Blastomycosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Pulmonary blastomycosis (moderately severe to severe): 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted
  • Follow with oral itraconazole.

Disseminated extrapulmonary blastomycosis(moderately severe to severe): 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted
  • Follow with oral itraconazole.

Immunocompromised patients with blastomycosis: 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Candida Urinary Tract Infection

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Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Patients undergoing urologic procedures: 0.3 to 0.6 mg/kg IV once a day for several days before and after the procedure

Fluconazole-resistant candida glabrata: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days

Symptomatic ascending candida pyelonephritis from fluconazole-resistant candida glabrata: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days
  • Use with or without flucytosine

Symptomatic ascending candida pyelonephritis from fluconazole-resistant candida kryseu: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days

Maximum IV dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Cystitis due to fluconazole-resistant species: 50 mg/mL in sterile water as a bladder irrigation once a day for 5 days

Candida urinary tract infection with fungus balls in patients with nephrostomy tubes: 25 to 50 mg in 200 to 500 mL sterile water IRRIGATED THROUGH the nephrostomy tubes

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.
  • Four week induction therapy is reserved for meningoencephalitis without neurological complications and cerebrospinal fluid yeast cultures that are negative after 2 weeks of treatment.
  • In patients with neurological complications, consider using 6 weeks of induction therapy.
  • If flucytosine is not given or treatment is interrupted, consider lengthening induction treatment at least 2 weeks.
  • Patients at low risk of therapeutic failure (e.g. early diagnosis, no uncontrolled underlying disease, not immunocompromised, and excellent clinical response) consider decreasing induction treatment to 2 weeks.

Use(s): Candiduria

Usual Adult Dose for Candidemia

Candida chorioretinitis without vitreous and with macular involvement: 5 to 10 mcg/0.1 mL sterile water by INTRAVITREAL injection

  • For use with concomitant antifungal treatment (oral or IV)

Central nervous system candidiasis in patients in whom a ventricular device cannot be removed: 0.01 to 0.5 mg in 2 mL of 5% dextrose administered THROUGH THE DEVICE into the ventricle

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Coccidioidomycosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Severe, non-meningeal infection: 0.7 to 1 mg/kg/day IV
Duration of therapy: Until clinical improvement
  • Follow with a triazole.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Use(s): Coccidioidomycosis

Usual Adult Dose for Cryptococcal Meningitis - Immunocompetent Host

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to thefinal daily dose depending on cardio-renal status.

Induction dose: 0.7 to 1 mg/kg IV once a day for at least 4 weeks
  • Use in combination with flucytosine.
  • Consolidation treatment is done with fluconazole.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.
  • Four week induction therapy is reserved for meningoencephalitis without neurological complications and cerebrospinal fluid yeast cultures that are negative after 2 weeks of treatment.
  • In patients with neurological complications, consider using 6 weeks of induction therapy.
  • If flucytosine is not given or treatment is interrupted, consider lengthening induction treatment at least 2 weeks.
  • Patients at low risk of therapeutic failure (e.g. early diagnosis, no uncontrolled underlying disease, not immunocompromised, and excellent clinical response) consider decreasing induction treatment to 2 weeks.

Use(s): Treatment of cryptococcal meningoencephalitis

Usual Adult Dose for Histoplasmosis - Immunocompetent Host

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Moderately severe to severe pulmonary histoplasmosis: 0.7 to 1 mg/kg IV once a day
Duration of therapy: 1 to 2 weeks
  • Follow with itraconazole.
  • May use concomitant methylprednisolone for respiratory complications.
  • Use this formulation if nephrotoxicity risk is low.

Moderately severe to severe progressive disseminated histoplasmosis: 3 mg/kg IV once a day
Duration of therapy: 1 to 2 weeks
  • Follow with itraconazole.
  • Use this formulation if nephrotoxicity risk is low.

Progressive disseminated histoplasmosis: 1 mg/kg IV once a day for 4 to 6 weeks
OR
1 mg/kg IV once a day for 2 to 4 weeks, followed by itraconazole
  • Longer therapy may be needed for severe disease, immunosuppression, or primary immunodeficiency disorders.

CNS histoplasmosis: 1 mg/kg IV once a day
Duration of therapy: 4 to 6 weeks
  • Follow with itraconazole.
  • Use this formulation if nephrotoxicity risk is low.

Histoplasmosis in pregnancy: 3 to 5 mg/kg IV once a day
Duration of therapy: 4 to 6 weeks
  • Use this formulation if nephrotoxicity risk is low.

Progressive disseminated histoplasmosis: 1 mg/kg IV once a day
Duration of therapy: 4 to 6 weeks; 2 to 4 weeks if followed by itraconazole
  • Longer therapy may be needed for severe disease, immunosuppression, or primary immunodeficiency.


Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.
  • Mild to moderate acute pulmonary histoplasmosis does not usually require treatment.

Usual Adult Dose for Oral Thrush

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Fluconazole-refractory oropharyngeal candidiasis: 0.3 mg/kg IV once a day

Esophageal candidiasis: 0.3 to 0.7 mg/kg IV once a day
  • Use only if patients cannot tolerate oral therapy.
  • Switch to oral fluconazole therapy when the patient can tolerate oral intake.

Fluconazole-refractory esophageal candidiasis: 0.3 to 0.7 mg/kg IV once a day
Duration of therapy: 21 days

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Sporotrichosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the final daily dose of 0.5 to 0.7 mg/kg IV once a day.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED
Cumulative dose: Up to 2.5 grams total
Duration of therapy: Up to 9 months

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Leishmaniasis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Visceral Leishmaniasis: 0.75 to 1 mg/kg IV once a day or every other day for 20 to 30 doses

Mucosal Leishmaniasis: 0.1 to 1 mg/kg IV once a day for 20 to 45 doses

Cutaneous Leishmaniasis: 0.7 mg/kg IV once a day for 25 to 30 doses

Mucocutaneous Leishmaniasis: 0.7 to 1 mg/kg IV every other day for up to 25 to 45 doses

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Usual Adult Dose for Mucormycosis - Invasive

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to a final daily dose of 0.5 to 0.7 mg/kg depending on cardio-renal status.
  • A cumulative dose of at least 3 grams is recommended; although 3 to 4 grams infrequently cause lasting renal impairment, the dose is considered reasonable if clinical evidence of deep tissue infection is present, as this infection usually follows a rapidly fatal course.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.
  • This disease generally occurs in association with diabetic ketoacidosis; it is imperative for diabetic control to be restored for treatment to be successful.

Use(s): Rhinocerebral mucormycosis (phycomycosis)

Usual Adult Dose for Systemic Fungal Infection

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes

  • If initial dose is well tolerated, increase over a period of 2 days to:
Maintenance dose: 0.25 to 1 mg/kg slow IV daily
Duration of therapy: 10 to 14 days

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.
  • This disease generally occurs in association with diabetic ketoacidosis; it is imperative for diabetic control to be restored for treatment to be successful.

Use(s): Systemic mycosis

Usual Pediatric Dose for Blastomycosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the recommended daily dose.

Children with severe blastomycosis: 0.7 to 1 mg/kg IV once a day
  • Follow with fluconazole

Newborns with evidence of infection: 1 mg/kg IV once a day

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Usual Pediatric Dose for Candidemia

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the maintenance dose.

Maintenance dose: 1 mg/kg IV once a day
  • An infusion time of 3 to 6 hours is recommended
Duration of therapy: 2 weeks after documented clearance of candida from the bloodstream, if neutropenia and candidemia symptoms have resolved

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Usual Pediatric Dose for Cryptococcal Meningitis - Immunosuppressed Host

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily
Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily
Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

  • Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Induction dose: 0.7 to 1 mg/kg IV once a day - with concomitant fluconazole or flucytosine
Duration of therapy: 5 to 7 days

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Use(s): HIV-infected patients or organ transplant recipients with cryptococcal disease (meningeal and disseminated non-meningeal)

Usual Pediatric Dose for Systemic Fungal Infection

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes

  • If initial dose is well tolerated, increase over a period of 2 days to:
Maintenance dose: 0.25 to 1 mg/kg slow IV daily
Duration of therapy: 10 to 14 days

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.
  • This disease generally occurs in association with diabetic ketoacidosis; it is imperative for diabetic control to be restored for treatment to be successful.

Use(s): Systemic mycoses

Usual Pediatric Dose for Sporotrichosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.
Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes

  • If initial dose is well tolerated, increase over a period of 2 days to final dosing.

Disseminated sporotrichosis: 0.7 mg/kg IV once a day
  • After a favorable response is seen, switch to itraconazole.

Maximum dose: 1.5 mg/kg total daily dose - UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Comments:
  • Administer primarily for progressive, potentially life-threatening fungal infections.
  • Excess dosage can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Administer by slow IV infusion, over approximately 2 to 6 hours, depending on dose.
  • The recommended concentration for infusion is 0.1 mg/mL.
  • Patient tolerance varies greatly; individualize dose based on patient clinical status (e.g. site and severity of infection, cardio-renal function).
  • A single test dose is preferred; monitor temperature, pulse, respiration, and blood pressure every 30 minutes for 2 to 4 hours.
  • Optimal daily doses and ideal treatment durations are unknown.

Use(s): Sporotrichosis

Renal Dose Adjustments

Use with caution

Liver Dose Adjustments

Data not available

Dose Adjustments

  • Whenever therapy is interrupted for 7 days or longer, resume therapy at the lowest dosage level and increase as outlined in dosage guidelines.

Pregnancy: Use for disseminated or CNS disease

Precautions

US BOXED WARNING(S):

  • This drug should be used PRIMARILY for progressive and potentially life-threatening fungal infections.
  • Do not use for noninvasive fungal disease such as oral thrush, vaginal candidiasis and esophageal candidiasis in patients with normal neutrophil counts.
  • Do not use injectable doses greater than 1.5 mg/kg.
  • EXERCISE CAUTION to prevent overdosage, which can lead to potentially fatal cardiac or cardiopulmonary arrest.
  • Verify the product name and dosage before administration, especially if dosage exceeds 1.5 mg/kg.

Consult WARNINGS section for additional precautions.

Dialysis

  • This product is poorly dialyzable and not hemodialyzable.

Other Comments

Administration advice:

  • VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG
  • Whenever therapy is interrupted for 7 days or longer, resume therapy at the lowest dosage level and increase as outlined in dosage guidelines.

Storage requirements:
  • Refrigerate; protect from light.

Monitoring:
  • Monitor renal function frequently during therapy.
  • Regularly monitor liver function, serum electrolytes (particularly potassium and magnesium), blood counts, and hemoglobin concentrations.
  • Use lab test results to guide dose adjustments.
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