Amphotericin B cholesteryl sulfate drug interactions

# Drug Interactions
No formal drug interaction studies have been conducted with AMPHOTEC. When administered concomitantly, the following drugs are known to interact with amphotericin B; therefore the following drugs may interact with AMPHOTEC.

# Antineoplastic Agents
Concurrent use of antineoplastic agents and amphotericin B may enhance the potential for renal toxicity, bronchospasm, and hypotension. Caution is urged when antineoplastic agents are given concomitantly with AMPHOTEC.

# Corticosteroids and Corticotropin (ACTH)
Concurrent use of corticosteroids and corticotropin (ACTH) with amphotericin B may potentiate hypokalemia which could predispose the patient to cardiac dysfunction. If corticosteroids or corticotropin are used concomitantly with AMPHOTEC, serum electrolytes and cardiac function should be monitored.

# Cyclosporine and Tacrolimus
In the same randomized, double-blind, empiric trial to compare AMPHOTEC and amphotericin B deoxycholate, patients with normal baseline serum creatinine were prospectively enrolled into four strata: adults receiving cyclosporine or tacrolimus (n=89); or pediatric patients (< 16 years old) receiving cyclosporine or tacrolimus (n=15); adults not receiving cyclosporine or tacrolimus (n=75); or pediatric patients not receiving cyclosporine or tacrolimus (n=34). Patients were assessed for renal toxicity defined as either a doubling or an increase of 1.0 mg/dL or more from baseline serum creatinine, or  50% decrease from baseline calculated creatinine clearance. Adults and pediatric patients receiving cyclosporine or tacrolimus in addition to AMPHOTEC had a significantly lower rate of renal toxicity (31%, 16/51), compared to the amphotericin B deoxycholate patients receiving cyclosporine or tacrolimus (68%, 34/50). In the adults and pediatric patients not receiving cyclosporine or tacrolimus, only 8% (4/51) of the AMPHOTEC patients experienced renal toxicity compared to 35% (17/49) of the amphotericin B deoxycholate patients.

# Digitalis Glycosides
Concurrent use of amphotericin B may induce hypokalemia and may potentiate digitalis toxicity. If digitalis glycosides are administered concomitantly with AMPHOTEC, serum potassium levels should be closely monitored.

# Flucytosine
Concurrent use of flucytosine with amphotericin B containing preparations may increase the toxicity of flucytosine by possibly increasing its cellular uptake and/or impairing its renal excretion. Caution is urged when flucytosine is given concomitantly with AMPHOTEC.

# Imidazoles
(e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.)
Antagonism between amphotericin B and imidazole derivatives such as miconazole and ketoconazole which inhibit ergosterol synthesis, has been reported in both in vitro and in vivo animal studies. The clinical significance of these findings has not been determined.

# Other Nephrotoxic Medications
Concurrent use of amphotericin B and agents such as aminoglycosides and pentamidine may enhance the potential for drug-induced renal toxicity. Caution is urged if aminoglycosides or pentamidine are used concomitantly with AMPHOTEC. Intensive monitoring of renal function is recommended in patients requiring any combination of nephrotoxic medications.

# Skeletal Muscle Relaxants
Amphotericin B-induced hypokalemia may enhance the curariform effect of skeletal muscle relaxants (e.g., tubocurarine) due to hypokalemia. If skeletal muscle relaxants are administered concomitantly with AMPHOTEC, serum potassium levels should be closely monitored.