Counseling of Amphotericin

Amphotericin is available in A and B form. Amphotericin A has no therapeutic activity while anphotericin B is used for therapeutic purpose. These are antifungal drug, produced by Streptomyces nodusa. It is used both for systemic and local effects.

Therapeutic Class:

Polyene antifungal drug

Counseling for Indication:

There are a number of diseases present in this world. Each disease is specifically treated with a specific medicine. Some diseases are common while some are rare. Indication of drug means that drug is used in treatment of a specific disease or symptom. One drug may have more than one indication. You should always use prescribed medicine for the prescribed purpose on by avoiding the trend of self-medication.

Amphotericin is indicated;for systemic fungal infection, active against most of fungus and yeast, aspergillosis, canadidiasis, cryptococcosis, alternate for visceral leishmaniasis patient resist to sodium stibogluconte, urinary irrigation for mycotic infection, for the maintenance of  Histoplasmosis.

Counseling for Dose:

Dose is different for the people of different age groups. Similarly, dose is also different for different route of administration or for different dosage forms. Pharmacist must counsel the patient about the drug dose. Patient should take the dose as prescribed. Taking of dose more than prescribed may lead to toxicity while taking the dose less than the prescribed dose leads to the sub-therapeutic effects. Thus, counseling of patient is required in this regard by the pharmacist. Dose of amphotericin can counsel in following way by pharmacist.

For lechmaniasis:

  • 1-3mg /kg daily for 21 days
  • Amphotericin lozenges can be allowed to dissolve slowly in mouth but they are less effective in resolving the stomatitis.

For mouth infection: 

Allow one lozenges to dissolve slowly in about 4 times a day for 10-15 days. Maximum dose is 8 lozenges per day

IV infusion:

0.20 mg/ml to 2.00 mg/ml is the concentration of amphotericin in infusion

It is not recommended in children less than 1 year.

Counseling for Mode of Action:

Each drug has its own mechanism of action. It is not necessary to counsel a patient about drug mechanism but if patient or caretaker ask about the mode of action of drug then pharmacist should counsel accordingly in simple and understandable words to satisfy the patient. No technical language is required as patient may not get it properly. Pharmacist can counsel about mode of action of amphotericin by saying that amphotericin binds to  ergo sterol, by which monovelant ion leakage occur it is due the formation of transmembrane channel and lead to death of fungus.

Counseling for Spectrum:

Each antimicrobial drug has a specific spectrum of activity which means antimicrobials are active against microbes of that specific spectra. Some are narrow spectrum and some are broad spectrum. It is not necessary to tell about spectrum. But if it is asked by the patient or caretaker, then pharmacist should tell it to the patient or caretaker. Amphotericin is used to treat disease or infection due to Candida krusei ,Fusarium oxysporum , Candida albicans ,Coccidioides immitis,Cryptococcus neoformans.

Counseling for Side Effects:

Undesired effects are always associated with medicine that come with a usual dose. There is no medicine without side effects. Some drugs have more side effects while some has less side effects. Side effects may be reversible or irreversible. It is not necessary that side effects will appear in all patients. They are mostly negligible but it is always important to tell your physician/pharmacist if side effects occur because some side effects are fatal. You need to discontinue the therapy immediately.

Pharmacist should counsel a patient/care taker about side effects properly. Side effects regarding to amphotericin are;

  • Infusion related toxicities are chills, GIT disturbances, hypotension, headache.
  • Cumulative toxicities are renal impairment, nephrotoxicity and abnormal hepatic function.

Counseling for Contraindications:

If a drug is contraindicated in some condition then it means you cannot take it in that condition. If medicines are given in contraindicated patient, then it can cause fatal effects.

It is very important for a pharmacist to tell about contraindications of the drugs being dispensed to the patient.  For example; aspirin is contraindicated in children due to high risk of Reye’s syndrome and salisylism.

Pharmacist should counsel to patient/care taker that amphotericin is contraindicated in kidney problems, in decreased amount of magnesium, potassium blood, increased level of mast cells, and patient hypersensitive to this medicine.

Counseling for Pregnancy:

Health and life of mother and newborn is very precious. There are large number of medicines that are very toxic in pregnancy if taken. So they should be avoided. There are FDA approved categories for all drugs. Some drugs can be given to pregnant women, some drug can be given on risk to benefit ratio while others are strictly prohibited. Few drugs have no clinical data.

Pharmacist should always counsel patient/ caretaker about these categories otherwise mother or newborn has to suffer severe results. Amphotericin  is category B drug. It can be given in pregnancy with great care on risk to benefit ratio.

Counseling for Dosage form:

In simple words, the way in which a drug is administered is known as dosage form.  Drug is design in a specific dosage form for its better results. All drugs cannot be design in one dosage form. Thus, multiple dosage forms for a single drug is available in the market to meet the conditions of patients. Dosage form is always designed for the convenience of patients.

It is responsibility of pharmacist to aware patient and caretaker about the dosage form to be dispensed.

  • IV injection
  • IV infusion
  • Lozenges
  • Topical preparations
  • Ocular preparation

Counseling for Interactions:

Drugs are basically substance having some definite structure and definite therapeutic function. When two or more drugs are combined for a therapy then interaction between these drugs may occur. This interaction may cause toxicity or nullify the effect of one drug on other, or may increase or decrease the effect of one drug. hence while prescribing a drug and dispensing a drug physician and pharmacist should remember these interactions. It is the duty of pharmacist to counsel a patient/care taker about drug interaction in simple and easy way. Interaction of amphotericin required following counseling by pharmacist.

  • Diuretics, cisplatin, corticosteroids, cause hypokalemia,
  • Nephrotoxic drugs, cytotoxic drugs, tenofovir, adefovir, foscarnet, ganciclovir cause renal impairment with amphotericin.
  • Risk of pulmonary lung impairment increase if leukocytes are administered with this medicine.

Brands:

Sometimes multiple brand make the patient or care taker confuse about its use. pharmacist may tell the patient or caretaker that which brand will more suitable for patients according to bioavaibility of drug, cost effectiveness, and reliability. Each brand has its own bioavailability rate in body hence give different efficacies. It is the role of pharmacist to clear the patient regarding brands. Following brands are available in market for amphotericin.

  • AmBisome®
  •  Abelcet®
  •  Fungizone®