암포테리신 B
Amphotericin B
다른 이름: Abelcet · AmBisome · Amphotec · Fungizone · Amphocil · Amphotericin B deoxycholate · Amphotericin B lipid complex · Liposomal amphotericin B · Anfotericina B · Amphotericinum B
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Susceptible systemic fungal infections (Rapid-Infusion Technique) | 0.25 mg/kg IV over 5 minutes, then 0.5 mg/kg 3 times a week until 9-12 mg/kg accumulated dosage is given | IV | 3 times a week | Until 9-12 mg/kg accumulated | 🌎 NA |
| Susceptible systemic fungal infections (Slow IV Infusion Technique) | 0.25 mg/kg IV over 4-6 hours, then 0.5 mg/kg 3 times a week until 9-12 mg/kg accumulated dosage is given | IV | 3 times a week | Until 9-12 mg/kg accumulated | 🌎 NA |
| Systemic fungal infections (Dehydrated/compromised) | 0.5 mg/kg diluted in D5W given by slow IV over 15 minutes (normal renal) or 3-6 hours (compromised renal) | IV | Every other day | Until cumulative dose of 8-10 mg/kg (or higher depending on disease) | 🌎 NA |
| Systemic mycoses (Lipid-based: AmBisome, Amphocil, Abelcet) | Test dose of 0.5 mg/kg; then 1-2.5 mg/kg IV q48h (or Monday, Wednesday, Friday) for 4 weeks or until the total cumulative dose is reached | IV | q48h | 4 weeks or until cumulative dose reached | 🌎 NA |
| Systemic mycoses (ABLC; Abelcet) | 2-3 mg/kg IV three days per week for a total of 9-12 treatments (cumulative dose of 24-27 mg) | IV | 3 days per week | 9-12 treatments | 🌎 NA |
| Blastomycosis | 0.5 mg/kg 3 times weekly until a total dose of 6 mg/kg is given | IV | 3 times weekly | Until 6 mg/kg cumulative | 🌎 NA |
| Blastomycosis | 0.15-0.5 mg/kg IV 3 times a week | IV | 3 times a week | Until total dose reaches 4-6 mg/kg, then start maintenance | 🌎 NA |
| Blastomycosis (severe cases, using Abelcet) | 1-2 mg/kg IV three times a week (or every other day) to a cumulative dose of 12-24 mg/kg | IV | 3 times a week | Until 12-24 mg/kg cumulative | 🌎 NA |
| Cryptococcosis | 0.5-0.8 mg/kg SC 2-3 times per week | SC | 2-3 times per week | — | 🌎 NA |
| Histoplasmosis | 0.15-0.5 mg/kg IV 3 times a week | IV | 3 times a week | Until total dose reaches 2-4 mg/kg, then start maintenance | 🌎 NA |
| Histoplasmosis | 0.5 mg/kg IV given over 6-8 hours. If dose is tolerated, increase to 1 mg/kg given on alternate days until total dose of 7.5-8.5 mg/kg cumulative dose is achieved | IV | Alternate days | Until 7.5-8.5 mg/kg cumulative | 🌎 NA |
| Leishmaniasis (Liposomal form) | 3-3.3 mg/kg IV 3 times weekly for 3-5 treatments | IV | 3 times weekly | 3-5 treatments | 🌎 NA |
| Leishmaniasis (AmBisome) | Give initial test dose of 0.5 mg/kg, then 3-3.3 mg/kg IV every 72-96 hours until a cumulative dose of 15 mg/kg is reached | IV | q72-96h | Until 15 mg/kg cumulative | 🌎 NA |
| Gastrointestinal pythiosis (ABLC; Abelcet) | 1-2 mg/kg IV three times weekly for 4 weeks (cumulative dose 12-24 mg) | IV | 3 times weekly | 4 weeks | 🌎 NA |
| Systemic fungal infections and leishmaniosis | Dose not specified in monograph; requires specific protocols | IV | As directed | Until clinical resolution | 🌍 EU |
- Susceptible systemic fungal infections (Rapid-Infusion Technique): Dilute in 30 mL of 5% dextrose. Flush with 10 mL D5W before and after.
- Susceptible systemic fungal infections (Slow IV Infusion Technique): Dilute in 250-500 mL of D5W.
- Systemic fungal infections (Dehydrated/compromised): Must rehydrate before administration. Discontinue if BUN exceeds 50 mg/dL.
- Systemic mycoses (Lipid-based: AmBisome, Amphocil, Abelcet): 1 mg/kg for susceptible yeast/dimorphic fungi (cumulative 12 mg/kg); 2-2.5 mg/kg for resistant filamentous fungi (cumulative 24-30 mg/kg).
- Systemic mycoses (ABLC; Abelcet): Dilute to 1 mg/mL in D5W and infuse over 1-2 hours.
- Blastomycosis: Given with ketoconazole.
- Blastomycosis: Given with ketoconazole.
- Cryptococcosis: Diluted in 0.45% NaCl with 2.5% dextrose. Concentrations >20 mg/L result in local irritation/sterile abscess.
- Histoplasmosis: Given with ketoconazole.
- Histoplasmosis: Alternative to ketoconazole treatment.
- Gastrointestinal pythiosis (ABLC; Abelcet): Follow-up medical therapy after surgical resection.
- Systemic fungal infections and leishmaniosis: Lipid formulations preferred if pre-existing renal insufficiency exists.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Susceptible systemic fungal infections (Rapid-Infusion Technique) | 0.25 mg/kg IV over 5 minutes 3 times a week until 9-12 mg/kg accumulated dosage is given | IV | 3 times a week | Until 9-12 mg/kg accumulated | 🌎 NA |
| Cryptococcosis | 0.25 mg/kg in 30 mL D5W IV over 15 minutes q48h | IV | q48h | 3-4 weeks after clinical signs resolve | 🌎 NA |
| Cryptococcosis | 0.15-0.4 mg/kg IV 3 times a week | IV | 3 times a week | Until total dose reaches 4-6 mg/kg, then start maintenance | 🌎 NA |
| Cryptococcosis | 0.5-0.8 mg/kg SC 2-3 times per week | SC | 2-3 times per week | — | 🌎 NA |
| Cryptococcosis (ABLC; Abelcet) | 1 mg/kg IV three days per week for a total of 12 treatments (cumulative dose of 12 mg) | IV | 3 days per week | 12 treatments | 🌎 NA |
| Histoplasmosis | 0.25 mg/kg in 30 mL D5W IV over 15 minutes q48h | IV | q48h | 4-8 weeks | 🌎 NA |
| Histoplasmosis | 0.15-0.5 mg/kg IV 3 times a week | IV | 3 times a week | Until total dose reaches 2-4 mg/kg, then start maintenance | 🌎 NA |
| Blastomycosis | 0.25 mg/kg in 30 mL D5W IV over 15 minutes q48h | IV | q48h | Until cumulative dose of 4 mg/kg is given | 🌎 NA |
| Blastomycosis | 0.15-0.5 mg/kg IV 3 times a week | IV | 3 times a week | Until total dose reaches 4-6 mg/kg, then start maintenance | 🌎 NA |
| Systemic fungal infections (e.g., cryptococcosis) | Dose not specified in monograph; requires specific protocols | IV | As directed | Until clinical resolution | 🌍 EU |
| Cryptococcosis (when IV access is problematic) | Dose not specified in monograph; requires specific protocols | SC | As directed | Until clinical resolution | 🌍 EU |
- Susceptible systemic fungal infections (Rapid-Infusion Technique): Dilute in 30 mL of 5% dextrose. Flush with 10 mL D5W before and after.
- Cryptococcosis: Given with flucytosine. Stop if BUN >50 mg/dL.
- Cryptococcosis: Given with flucytosine.
- Cryptococcosis: Diluted in 0.45% NaCl with 2.5% dextrose (400 mL for cats).
- Cryptococcosis (ABLC; Abelcet): Dilute to 1 mg/mL in D5W and infuse over 1-2 hours.
- Histoplasmosis: Given with ketoconazole. Stop if BUN >50 mg/dL.
- Histoplasmosis: Given with ketoconazole.
- Blastomycosis: Given with ketoconazole. Stop if BUN >50 mg/dL.
- Blastomycosis: Given with ketoconazole.
- Systemic fungal infections (e.g., cryptococcosis): SC alternative has been used for cryptococcosis if regular venous catheterization is problematic.
- Cryptococcosis (when IV access is problematic): SC route used as an alternative to IV.
소형 포유류
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Susceptible systemic fungal infections (Rabbits) | 1 mg/kg/day IV | IV | q24h | — | 🌎 NA |
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Aspergillosis (raptors and psittacines) | 1.5 mg/kg IV three times daily for 3 days | IV | q8h | 3 days | 🌎 NA |
| Aspergillosis (raptors and psittacines) | 1 mg/kg diluted in sterile water once to 3 times daily for 3 days | Intratracheal | q8-24h | 3 days | 🌎 NA |
| Aspergillosis | 1.5 mg/kg IV q12h for 3-5 days; topically in the trachea at 1 mg/kg q12h; 0.3-1 mg/mL nebulized for 15 minutes 2-4 times daily | IV/Intratracheal/Nebulization | Variable | 3-5 days (IV) | 🌎 NA |
| Macrorhabdiasis (Microrhabdus ornithogaster) | 100-150 mg/kg PO q12h for 30 days | PO | q12h | 30 days | 🌎 NA |
- Aspergillosis (raptors and psittacines): With or followed by flucytosine.
- Aspergillosis (raptors and psittacines): In conjunction with flucytosine.
- Macrorhabdiasis (Microrhabdus ornithogaster): Treatment failures common with shorter durations.
파충류
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Susceptible fungal respiratory infections | 1 mg/kg diluted in saline and given intra-tracheally once daily for 14-28 treatments | Intratracheal | q24h | 14-28 treatments | 🌎 NA |
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Fungal pneumonia | Day 1: 0.3 mg/kg IV; Day 2: 0.4 mg/kg IV; Day 3: 0.6 mg/kg IV; days 4-7: no treatment; then every other day until a total cumulative dose of 6.75 mg/kg has been administered | IV | Variable | Until 6.75 mg/kg cumulative | 🌎 NA |
| Phycomycoses and pulmonary mycoses | Day 1: 0.3 mg/kg IV; Day 2: 0.45 mg/kg IV; Day 3: 0.6 mg/kg IV; then every other day for 3 days per week (MWF or TTHSa) | IV | Variable | 10-80 days | 🌎 NA |
| Intrauterine infusion | 200-250 mg | Intrauterine | q24h or q48h | 3-7 days | 🌎 NA |
- Phycomycoses and pulmonary mycoses: Administer in 1L D5W at 1 L/hr. Adjust if toxicity occurs.
- Intrauterine infusion: Little science available for recommending doses/diluents.
양
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Susceptible systemic fungal infections (Llama) | 1 mg test dose, then initially at 0.3 mg/kg IV over 4 hours... Subsequent doses were increased by 10 mg and given every 48 hours until reaching 1 mg/kg q48h IV for 6 weeks | IV | q48h | 6 weeks | 🌎 NA |
- Susceptible systemic fungal infections (Llama): Single case report in a Llama (Coccidioidomycosis).
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
암포테리신 B(Amphotericin B)는 진행성이며 치명적일 수 있는 진균 감염(예: 분아균증, 히스토플라스마증, 크립토코쿠스증, 콕시디오이데스증)에 사용되는 강력한 전신성 폴리엔 마크로라이드계 항진균제입니다.
경구 생체이용률이 낮아 반드시 비경구(일반적으로 IV)로 투여해야 합니다. 기존 형태인 데옥시콜산 암포테리신 B는 심각한 신독성을 유발하는 것으로 악명이 높으며, 이로 인해 사용이 제한되고 집중적인 모니터링이 필요합니다.
새로운 지질 기반 제제(예: 리포솜 암포테리신 B, 암포테리신 B 지질 복합체)는 약물을 지질 운반체에 캡슐화한 것입니다. 이러한 제제는 신독성이 현저히 낮고 더 높은 누적 용량을 허용하며 조직(폐, 간, 비장 등) 침투력이 더 좋지만 비용이 상당히 비쌉니다.
임상 팁: 많은 이형성 진균에 매우 효과적이지만, 개와 고양이의 아스페르길루스증은 암포테리신 B 치료에 만족스럽게 반응하지 않는 경우가 많습니다.
작용 기전
Amphotericin B is fungistatic or fungicidal depending on the concentration.
It works by binding to sterols—primarily ergosterol—in the fungal cell membrane. This binding creates transmembrane pores → alters membrane permeability → allows intracellular potassium (K+), magnesium, and other vital cellular constituents to leak out → leading to fungal cell death.
Toxicity Mechanism: Mammalian cell membranes contain cholesterol. While amphotericin B has a higher affinity for ergosterol, it still binds to mammalian cholesterol to some degree. This cross-reactivity, particularly in renal epithelial cells, is the primary mechanism behind its dose-limiting nephrotoxicity. It also induces renal vasoconstriction, leading to a decreased glomerular filtration rate (GFR).
안전성·주의사항
금기사항
- Patients with known hypersensitivity to amphotericin B (unless the infection is life-threatening and no alternatives exist)
부작용
- Nephrotoxicity (very common, dose-dependent)
- Anorexia and vomiting
- Hypokalemia and hypomagnesemia
- Distal renal tubular acidosis
- Phlebitis at injection site
- Cardiac arrhythmias
- Non-regenerative anemia
- Fever (can be mitigated with NSAIDs or low-dose steroids)
- Tachycardia, tachypnea, lethargy, restlessness (horses)
- Calcinosis cutis (dogs)
주의
Black Box Warning Equivalent: Amphotericin B is highly nephrotoxic. Renal function must be aggressively monitored during therapy.
- Use with extreme caution in patients with pre-existing renal disease.
- Cats are more sensitive to nephrotoxic effects; reduced dosages are often recommended.
- Ensure adequate hydration prior to administration. Sodium loading (e.g., normal saline administration before and after dosing) may help avert renal insufficiency by preventing tubuloglomerular feedback-induced vasoconstriction.
- Pregnancy: Weigh risks vs. benefits. FDA Category B (human); Papich Class A (veterinary).
약물 상호작용
May exacerbate the potassium-losing effects of amphotericin B.
Amphotericin B-induced hypokalemia may exacerbate digoxin toxicity.
In vitro synergy against Cryptococcus and Candida, but may also increase flucytosine toxicity.
Additive renal toxicity; avoid concurrent or sequential use if possible.
Increased risk of severe hypokalemia.
Reconstituting amphotericin B deoxycholate with these solutions may cause precipitation.
Amphotericin B-induced hypokalemia may enhance curariform effects.
Amphotericin may increase the toxic effects of fluorouracil.
Amphotericin may increase the toxic effects of doxorubicin.
Amphotericin may increase the toxic effects of methotrexate.
Concurrent use significantly increases the risk of severe nephrotoxicity.
모니터링
- BUN and serum creatinine (before each dose or every other day during dose escalation, then at least weekly)
- Serum electrolytes including sodium, potassium, and magnesium (weekly)
- Liver function tests (weekly)
- CBC and Packed Cell Volume (PCV) (weekly)
- Urinalysis (weekly)
- Total plasma protein (TPP) (at least weekly)
- Body weight
약동학
반감기
흡수
Poorly absorbed from the GI tract; must be given parenterally (IV) for systemic infections.
분포
Penetrates well into most tissues but poorly into pancreas, muscle, bone, aqueous humor, and pleural/pericardial/synovial/peritoneal fluids unless inflamed. CSF levels are ~3% of serum levels. Highly protein bound (90-95%). Lipid forms have higher penetration into lungs, liver, and spleen.
대사
Metabolic pathways are not fully known.
배설
Exhibits biphasic elimination. Approximately 2-5% of the drug is recovered in the urine in unchanged (biologically active) form. Can be detected in urine up to 7 weeks after therapy stops.
과다투여
Acute intravenous overdose reports are rare. Because of the severe toxicity of the drug, dosage calculations and solution preparation procedures must be double-checked.
If an accidental overdose occurs, renal toxicity is the primary concern. Toxicity may be minimized by aggressively administering intravenous fluids and mannitol to maintain GFR and promote diuresis.
제품
제형
- Powder for injection (Deoxycholate)
- Suspension for injection (Lipid complex)
- Powder for injection (Liposomal/Cholesteryl sulfate complex)
- Topical formulations
인용의약품
- Amphotericin B Desoxycholate Powder for Injection: 50 mg in vials
- Amphotericin B Lipid-Based Suspension for Injection: 100 mg/20 mL (Abelcet)
- Amphotericin B Lipid-Based Powder for Injection: 50 mg, 100 mg (Amphotec, AmBisome)
- Topical formulations (Fungizone)
규제 현황
Human authorized products used under the cascade.
Human authorized products used under the cascade.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store un-reconstituted vials in the refrigerator (2-8°C), protected from light and moisture. Reconstitute with sterile water for injection (no preservatives). After reconstitution, stable for 24 hours at room temperature and 1 week refrigerated if protected from light. When diluted in D5W (pH >4.3) for IV use, protect from light during administration (though studies show potency remains largely unaffected for 8-24 hours of light exposure).
보호자 정보
암포테리신 B는 심각하고 생명을 위협하는 진균 감염에만 사용되는 강력한 항진균제입니다.
- 투여 방법: 반드시 주사(일반적으로 정맥 주사)로 투여해야 하며, 이를 위해 반려동물이 입원하거나 동물병원을 자주 방문해야 하는 경우가 많습니다.
- 신장 위험: 이 약물은 신장에 매우 강한 독성을 나타냅니다. 대부분의 반려동물은 어느 정도의 신장 스트레스를 겪게 됩니다. 신장 기능을 면밀히 모니터링하기 위해 혈액 및 소변 검사를 자주 실시할 것입니다.
- 부작용: 구토, 식욕 부진, 극심한 무기력 또는 발열과 같은 질병의 징후가 있는지 관찰하십시오. 이러한 증상이 나타나면 즉시 수의사에게 연락하십시오.
- 비용 및 헌신: 치료 비용이 많이 들 수 있으며 모니터링 및 투여를 위해 상당한 시간적 헌신이 필요합니다.
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