1 May 2026Injectable drugsSource update: March 2024
Amphotericin B liposomal injectable
Liposomal amphotericin B guidance for selected severe fungal disease and leishmaniasis, with reduced nephrotoxicity compared with conventional amphotericin.
Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
Therapeutic action
Antifungal.
Indications
- Cryptococcal meningitis, when conventional amphotericin B is contra-indicated.
- Mucocutaneous or visceral leishmaniasis.
- Severe histoplasmosis.
Forms and strengths, route of administration
- Powder for injection, in 50 mg vial, dissolved in 12 ml water for injection to obtain a concentrated suspension containing 4 mg/ml.
- Withdraw the required dose, pass it through the provided filter, and inject into 5% glucose to obtain a final concentration between 0.2 and 2 mg/ml for IV perfusion.
Dose and duration
| Weight | Liposomal amphotericin B, 50 mg-vial in 12 ml | G5% | ||
|---|---|---|---|---|
| Daily dose in mg | Nb of vials | Volume of suspension (4 mg/ml) to be withdrawn | Volume required for administration | |
| 4 kg | 12 | 1 | 3 ml | 50 ml |
| 5 kg | 15 | 4 ml | ||
| 6 kg | 18 | 4.5 ml | ||
| 7 kg | 21 | 5 ml | ||
| 8 kg | 24 | 6 ml | ||
| 9 kg | 27 | 7 ml | ||
| 10 kg | 30 | 7.5 ml | ||
| 15 kg | 45 | 11 ml | ||
| 20 kg | 60 | 2 | 15 ml | 250 ml |
| 25 kg | 75 | 19 ml | ||
| 30 kg | 90 | 23 ml | ||
| 35 kg | 105 | 3 | 26 ml | 500 ml |
| 40 kg | 120 | 30 ml | ||
| 45 kg | 135 | 34 ml | ||
| 50 kg | 150 | 38 ml | ||
| 55 kg | 165 | 41 ml | ||
| 60 kg | 180 | 45 ml |
Cryptococcal meningitis, severe histoplasmosis
- Child over 1 month and adult: 3 mg/kg once daily over 30 to 60 minutes for 2 weeks.
Mucocutaneous or visceral leishmaniasis
Follow the recommended regional protocol. For information, the total dose in children over 1 month and adults is 15 to 30 mg/kg.
Contra-indications, adverse effects, precautions
- Due to numerous and potentially severe adverse effects, patients should be kept under close surveillance.
- May cause infusion intolerance reactions, local thrombophlebitis, allergic reactions, gastrointestinal disturbances, renal-function disturbances, hypokalaemia, hypomagnesiemia, elevated liver enzymes, and rarely thrombocytopenia or anaemia.
- Avoid combination with drugs causing hypokalaemia, nephrotoxic drugs, digoxin, and zidovudine.
- The infusion may be administered over 2 hours if necessary to prevent or minimize adverse effects.
- Monitor serum creatinine and, if possible, serum potassium throughout treatment and adapt supplementation according to results.
- If renal function deteriorates, reduce the dose by half for a few days.
- Pregnancy: check for renal dysfunction in the neonate if administered during the last month of pregnancy.
- Breast-feeding: avoid, except if vital.
- Liposomal amphotericin B is better tolerated and less nephrotoxic than conventional amphotericin B.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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