Liposomal Amphoteracin Infusion Information Sheet

(Ambisome)

MUST BE PRESCRIBED BY BRAND NAME

INDICATIONS FOR AMBISOME THERAPY

1. Where conventional amphotericin (unresponsive within 48 hours) has failed or recurrent infection in
which conventional amphoteracin previously failed.

2. Where there is concern over the toxicity of conventional amphotericin.

General:

• Always flush line/cannula before and after each dose and dilute Ambisome with
5% glucose.
• Ambisome should never be flushed with or reconstitued with 0.9% sodium
chloride as they are incompatible.
• Ambisome infusion should be a final concentration of 0.2 - 2mg/ml.
• Follow advice in manufacturer’s instructions about using filters.
• Infusions should be used immediately after dilution and protected from light.
• Ambisome vials are kept in the fridge.
• Electolytes especially Mg and K, renal function , FBC, LFTs should be monitored
daily.
• The maximum dose is 3mg/kg/day. Higher doses have been given in
haematology patients with proven infection – seek advice.
• Note: it is not always necessary to do the escalating dose – seek advice

Initial Dose: 1mg/kg = ___________ mg

• Reconsitute each 50mg vial of Ambisome with 12ml sterile water for injection and
shake vigorously for 30 seconds until clear. (Concentration of resulting solution
is 4mg/ml).
• Withdraw ________ mls and add to __________ 5% glucose infusion bag.
• For test dose infuse ________ mls (1mg) over 10 minutes and observe patient
for further 30 minutes.
• Infuse the rest of the bag over 30 mins to 1 hour
• If patient complains of ‘flu like’ symptoms decrease the rate of the infusion.

Day 2: 2mg/kg = ___________ mg

• Reconstitute vial as above.

• Add ________ mls to __________ ml bag of5% glucose.
• Infuse as above but no need for test dose.

Day 3 onwards: 3mg/kg = _____________ mg

• As for day 2 but add _________ mls to __________ ml bag of 5% glucose.

Magnesium and Potassium Intravenous Infusions

• If these are required according to the patients blood results they should not be
mixed in the same bag.
• Magnesium (Mg)
• Use magnesium sulphate 50% injection
• 10ml ampoule contains 20mmol
• 1g Mg = 4.1mmol
• Dilute with NaCl 0.9% or Glucose 5% before infusion
• Usual rate of infusion is 4mmol/hr.
• Sample at least 2 hours after the end of the infusion.

• Potassium (K)
• Use ready mixed bags of available on the ward.
• Maximum rate of infusion is 10mmol/hr.
• Maximum concentration of infusion bag is 40mmol/L.
• More concentrated bags may be used if patient has a central line – seek
advice.
• Consider adding amiloride 5 – 10 mg daily if necessary in patients who
require repeated potassium infusions to reduce potassium loss – seek advice.