Usual Adult Dose for Aspergillosis - Invasive

3 to 5 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Uses: Treatment of Aspergillus species, Candida species and/or Cryptococcus species infections refractory to amphotericin B deoxycholate, or where renal impairment or toxicity precludes use of amphotericin B deoxycholate.

Usual Adult Dose for Candidemia

3 to 5 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Uses: Treatment of Aspergillus species, Candida species and/or Cryptococcus species infections refractory to amphotericin B deoxycholate, or where renal impairment or toxicity precludes use of amphotericin B deoxycholate.

Usual Adult Dose for Cryptococcosis

3 to 5 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Uses: Treatment of Aspergillus species, Candida species and/or Cryptococcus species infections refractory to amphotericin B deoxycholate, or where renal impairment or toxicity precludes use of amphotericin B deoxycholate.

Usual Adult Dose for Febrile Neutropenia

3 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Use: Empiric therapy for presumed fungal infection in febrile, neutropenic patients.

Usual Adult Dose for Cryptococcal Meningitis - Immunosuppressed Host

6 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Use: Treatment of Cryptococcal meningitis in HIV infected patients

Usual Adult Dose for Leishmaniasis

Immunocompetent patients: 3 mg/kg/day IV on days 1 through 5, and days 14 and 21

• Infuse over 120 minutes.
• If parasitic clearance is not achieved, a repeat course may be useful.

Immunocompromised patients: 4 mg/kg/day IV on days 1 through 5, and days 10, 17, 24, 31 and 38

• Infuse over 120 minutes.
• If parasitic clearance is not achieved or relapse occurs, seek expert advice regarding further treatment.

Comments:

• Relapse rates after initial clearance of parasites were high in immunocompromised patients treated with this drug.
• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Use: Treatment of visceral leishmaniasis

Usual Adult Dose for Coccidioidomycosis

Severe, non-meningeal infection: 3 to 5 mg/kg/day IV
Duration of therapy: Until clinical improvement

• Follow with triazole

Use: Coccidioidomycosis

Usual Adult Dose for Blastomycosis

Moderate to severe pulmonary blastomycosis: 3 to 5 mg/kg/day IV
Duration of therapy: 1 to 2 weeks or until improvement is noted

• Follow with itraconazole

Moderate to severe extrapulmonary blastomycosis: 3 to 5 mg/kg/day IV
Duration of therapy: 1 to 2 weeks or until improvement is noted

• Follow with itraconazole

CNS blastomycosis: 5 mg/kg/day IV
Duration of therapy: 4 to 6 weeks

• Follow with an oral azole

Blastomycosis, immunosuppressed patient: 3 to 5 mg/kg/day IV
Duration of therapy: 1 to 2 weeks or until improvement is noted

• Follow with itraconazole

Blastomycosis during pregnancy: 3 to 5 mg/kg/day IV
Duration of therapy: 1 to 2 weeks or until improvement is noted

• Avoid azoles because of possible teratogenicity

Use: Blastomycosis

Usual Pediatric Dose for Aspergillosis - Invasive

1 month and older:
3 to 5 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Uses: Treatment of Aspergillus species, Candida species and/or Cryptococcus species infections refractory to amphotericin B deoxycholate, or where renal impairment or toxicity precludes use of amphotericin B deoxycholate.

Usual Pediatric Dose for Candidemia

1 month and older:
3 to 5 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Uses: Treatment of Aspergillus species, Candida species and/or Cryptococcus species infections refractory to amphotericin B deoxycholate, or where renal impairment or toxicity precludes use of amphotericin B deoxycholate.

Usual Pediatric Dose for Cryptococcosis

1 month and older:
3 to 5 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Uses: Treatment of Aspergillus species, Candida species and/or Cryptococcus species infections refractory to amphotericin B deoxycholate, or where renal impairment or toxicity precludes use of amphotericin B deoxycholate.

Usual Pediatric Dose for Febrile Neutropenia

1 month or older:
3 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Use: Empiric therapy for presumed fungal infection in febrile, neutropenic patients.

Usual Pediatric Dose for Cryptococcal Meningitis - Immunosuppressed Host

1 month or older:
6 mg/kg/day IV over 120 minutes

Comments:

• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Use: Treatment of Cryptococcal meningitis in HIV infected patients

Usual Pediatric Dose for Leishmaniasis

1 month or older:
Immunocompetent patients: 3 mg/kg/day IV on days 1 through 5, and days 14 and 21

• Infuse over 120 minutes.
• If parasitic clearance is not achieved, a repeat course may be useful.

Immunocompromised patients: 4 mg/kg/day IV on days 1 through 5, and days 10, 17, 24, 31 and 38

• Infuse over 120 minutes.
• If parasitic clearance is not achieved or relapse occurs, seek expert advice regarding further treatment.

Comments:

• Relapse rates after initial clearance of parasites were high in immunocompromised patients treated with this drug.
• Individualize dosing and rate of infusion to ensure maximum efficacy and minimize toxicities or adverse events.

Use: Treatment of visceral leishmaniasis

Renal Dose Adjustments

Data not available

• This drug has been successfully administered to patients with pre-existing renal impairment.

Liver Dose Adjustments

Data not available

Precautions

Safety and efficacy have not been established in patients younger than 1 month.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

• Hemodialysis or peritoneal dialysis do not appear to significantly affect elimination of this drug.

Other Comments

Administration advice:

• Administer over approximately 120 minutes using a controlled infusion device.
• Administration time can be reduced to 60 minutes if treatment is well tolerated.
• Administration time can be increased if the patient experiences discomfort.
• An inline filter may be used if mean pore diameter is not less than 1 micron.
• Existing IV line must be flushed with 5% dextrose prior to administration; if line cannot be flushed with 5% dextrose, administer through a separate line.

Storage requirements:

• Store at temperatures up to 77F.

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

IV compatibility:

• Dilute with 5% dextrose.
• Not compatible with saline.
• Do not mix with other drugs.

General:

• Carefully observe patients during the initial dosing period.