Amphotericin (Fungizone)

How does it work?

Fungizone infusion contains the active ingredient amphotericin, which is a type of medicine called an antifungal. It is used to treat infections caused by fungi and yeasts.

Amphotericin kills fungi and yeasts by interfering with their cell membranes. It works by binding to a substance called ergosterol, which is an essential component of fungal cell membranes. This disrupts the fungal cell membrane, causing holes to appear in it.

The cell membranes of fungi are vital for their survival. They keep unwanted substances from entering the cells and stop the contents of the cells from leaking out. As amphotericin causes holes to appear in the cell membranes, essential constituents of the fungal cells can leak out. This kills the fungi and treats the infection.

Amphotericin is not absorbed into the bloodstream when given by mouth. To treat severe fungal or yeast infections that are affecting the whole body and are potentially life-threatening, amphotericin must be given by a drip into a vein (intravenous infusion). Fungizone infusion is a conventional water-based form of amphotericin. Unfortunately, this form of amphotericin commonly causes side effects, particularly on the kidneys, and so cannot be given in high enough doses to treat infections in some people. People who can't be given Fungizone due to problems with its side effects, particularly its kidney side effects, may be given a liposomal form of amphotericin, such as Abelcet, AmBisome or Amphocil, as higher doses of these can be given with fewer side effects. See the factsheets linked at the end of this page for more information.

Fungizone solution may also be made into a bladder irrigation to treat candidal infections of the bladder, or lung inhalations to treat aspergillosis affecting the lungs. It may also be given by injection into the spinal column (intrathecal injection) to treat coccidiodal meningitis. The solution has also been used to bathe the ear, eye, peritoneum, lung cavities and joint spaces to treat fungal infections in these areas.

What is it used for?

  • Severe potentially life-threatening fungal infections affecting the body as a whole (systemic infection), for example cryptococcosis, North American blastomycosis, invasive candidiasis, coccidioidomycosis and histoplasmosis, mucormycosis, aspergillosis.
  • Protozoal infection called American mucocutaneous leishmaniasis

Warning!

  • When amphotericin is administered into a vein it may rarely cause a severe allergic reaction (anaphylaxis). For this reason, it is recommended that a small test dose is given before the first infusion. The patient should be carefully observed for signs of an allergic reaction for about 30 minutes after the test dose.
  • During treatment with this medicine you should have regular blood tests to monitor your kidney function, liver function, levels of blood cells and levels of electrolytes (salts such as potassium and magnesium) in your blood. This is particularly important if you already have any problems with your kidneys.

Use with caution in

  • Decreased kidney function
  • Decreased liver function

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine is not known to be harmful when used during pregnancy. However, the manufacturer states that it should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus. For life-threatening disease, the benefit of treatment is likely to outweigh any risks. Seek medical advice from your doctor.
  • There is no information available regarding the safety of this medicine during breastfeeding. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Chills
  • Fever (pyrexia)
  • Headache
  • Nausea and vomiting
  • Diarrhoea
  • Abdominal pain
  • Loss of appetite and weight loss
  • Muscle and joint pains
  • Pain and inflammation of the blood vessel at the site of injection
  • Disturbances in the number of blood cells in the blood, eg anaemia
  • Low blood potassium level (hypokalaemia)
  • Decreased kidney function
  • Abnormal heart beats (arrhythmias)
  • Low or high blood pressure (hypotension or hypertension)
  • Rash or itching
  • Hearing loss
  • Ringing or other noise in the ears (tinnitus)
  • Dizziness
  • Blurred or double vision
  • Flushing
  • Pins and needles sensations
  • Abnormal liver function tests
  • An extreme allergic reaction (anaphylaxis)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines during treatment this one, to ensure that the combination is safe.

There may be an increased risk of side effects on the kidneys if this medicine is used in combination with other medicines that can have side effects on the kidneys. Some of these are listed below. People receiving treatment with any of these in combination with amphotericin should have their kidney function regularly monitored:

  • aminoglycoside antibiotics, eg gentamicin
  • ciclosporin
  • tacrolimus
  • pentamidine
  • polymixin
  • vancomycin
  • zidovudine (there may also be an increased risk of side effects on the blood cells if amphotericin is used with zidovudine. Blood counts and kidney function should be monitored in people on this combination.)

There may be an increased risk of a drop in the amount of potassium in the blood (hypokalaemia) if this medicine is used in combination with any of the following:

  • corticosteroids, eg hydrocortisone, fludrocortisone, prednisolone, dexamethasone
  • corticotropin (ACTH)
  • diuretics, eg bendroflumethiazide, furosemide.

If hypokalaemia occurs due to amphotericin treatment, this may increase the risk of side effects from digoxin.

Amphotericin may increase the blood level of flucytosine, which could increase the risk of its side effects.

Amphotericin may be less effective at treating infection if it is used in combination with azole-type antifungals such as fluconazole, ketoconazole, itraconazole or miconazole.

Other medicines containing the same active ingredient

Abelcet AmBisome Amphocil
Fungilin lozenges Fungilin oral suspension Fungilin tablets