Amphotericin B - Not so terrible

OBJECTIVE: To describe a patient who developed adverse reactions to two dif ferent lipid formulations of amphotericin B: liposomal amphotericin B (AmBi some) and amphotericin B colloidal dispersion (ABCD, Amphocil), yet tolerat ed amphotericin B deoxycholate (Fungizone) despite renal toxicity. CASE SUMMARY: A 72-year-old woman with acute myelomonocytic leukemia was tr eated with amphotericin B deoxycholate for suspected pulmonary aspergillosi s; the drug was well tolerated but resulted; in renal failure;:Antifungal t herapy was then changed to liposomal amphotericin B. Within 10 minutes of l iposomal amphotericin B infusion, the patient developed severe dyspnea, che st pain, and a feeling of imminent death. On the following day, liposomal a mphotericin B:was switched to amphotericin B colloidal dispersion. Again, w ithin 10 minutes of this infusion, the patient developed fever,chills hypot ension, severe chest pain, dsypnea, and a feeling of imminent death, The pa tient refused any further treatment with these drugs and insisted on switch ing back to amphotericin B deoxycholate, which was then administered for 10 days and was well tolerated. DISCUSSION: Severe adverse reactions, such as anaphylaxis, cardiac toxicity , and respiratory failure, following administration of ail three lipid form ulations of amphotericin B have been reported. In most reported cases, swit ching to a different lipid formulation of amphotericin B was well tolerated . This is in contrast to our case, where a severe reaction was repeated whe n another lipid preparation was given, necessitating switching back to amph otericin B deoxycholate despite its nephrotoxicity. CONCLUSIONS: In some patients, paradoxically, lipid formulations of amphote ricin B may be less tolerable than conventional amphotericin B.