Aspergillosis

Comments Causes acute infusion-related reactions—fever, rigor, chills, myalgia, arthralgia, nausea, vomiting, headache, bronchospasm; dose-limiting nephrotoxicity characterized by azotemia, urinary wasting of potassium and magnesium, renal tubular acidosis and impaired urinary concentration ability; renal toxicity often leads to renal failure and dialysis, and excess mortality Lower toxicity than D-AMB allows for the higher dosages necessary to obtain equivalent efficacy; all 3 LFABs are kidney sparing; infusion-related side effects of fever, chills, and rigor less frequent with L-AMB than with D-AMB; substernal chest discomfort and flank pain noted in L-AMB infusion; hypoxic episodes associated with chills and fever more frequent with ABCD than with D-AMB FDA approved for primary treatment of IA; caution advised for IV use in patients with renal impairment; benefits and risks of IV solution should be made on a per-patient basis; Cmax and AUC increase disproportionally with increasing dose; monitor for drug-drug interactions; transient visual disturbances; possible dose-limiting hepatotoxicity, skin rash, visual hallucinations Licensed for treatment of IA in patients refractory or intolerant to standard antifungal therapy; absorption from capsule is enhanced by low gastric pH and dietary lipids and when taken with food or acidic cola beverages, but may be erratic in fasting state; not recommended for seriously ill patients with life-threatening infection; transient adverse reactions include nausea, vomiting, hypertriglyceridemia, and elevated hepatic enzymes; administer with caution in patients with ventricular dysfunction; serious interactions with some chemotherapeutic agents FDA approved for prevention of IA in neutropenic patients receiving remission induction chemotherapy for acute myelogenous leukemia and myelodysplastic syndrome; demonstrates activity in prevention of IA in HSCT recipients with GVHD; adverse reactions include fever, hypokalemia, thrombocytopenia, anemia, diarrhea, nausea; associated with prolongation of the QT interval; administer with caution to patients with potentially proarrhythmic conditions; should not be administered with drugs that are known to prolong the QTc interval and that are metabolized through CYP3A4 FDA approved for second-line treatment of IA—in patients refractory or intolerant to other antifungal therapies; can be used in combination with available standard antifungal agents; minimal adverse effects, with increased liver enzymes, gastrointestinal upset, and headaches being most frequent; no significant potential for drug interactions—but cyclosporine increases AUC of caspofungin FDA approved for nonaspergillosis indications, but has activity against aspergillosis FDA approved for nonaspergillosis indications, but has activity against aspergillosis CT, hematopoietic stem cell transplantation; GVHD, graft-versus-host disease.

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