Prevent Mix-Ups With Amphotericin B Shortages

Amphotericin B lipid complex (ABLC) continues to face shortages...without an estimated release date.

The shortage is ongoing since 2022...due to manufacturing issues.

Amphotericin B is often reserved for severe, life-threatening fungal infections (cryptococcal meningitis, etc) that are resistant to other therapies (fluconazole, etc).

Keep an eye on how many ABLC vials you have in stock. If your supply is completely depleted, anticipate your institution ordering liposomal amphotericin B (LAmB) as an alternative.

But remember, NONE of the amphotericin formulations are interchangeable.

And don’t confuse ABLC and LAmB with amphotericin deoxycholate. This is often called “conventional” amphotericin...and is usually saved as a last resort due to infusion reactions, kidney damage, etc.

Deadly errors have occurred when liposomal amphotericin B was intended...but the conventional product was accidentally used instead. This has led to ISMP classifying amphotericin B as a high-alert med.

Watch doses closely...since the max dose for lipid formulations is higher than conventional. For example, a patient who weighs 60 kg can get up to 300 mg/day of ABLC...but only 90 mg of conventional amphotericin B.

Alert the pharmacist if an order you’re compounding requires a larger amount of conventional amphotericin vials than you’re used to seeing. He or she will want to investigate further.

Look closely at the name AND strength of the vials before reconstituting. LAmB and conventional amphotericin both come in 50 mg vials...but ABLC comes in 100 mg.

Don’t be surprised to see brand AND generic names listed on orders, the MAR, automated dispensing cabinets (ADCs), pharmacy labels, etc...along with the formulation (“liposomal” for LAmB orders, etc).

Use barcode scanning to confirm the product when prepping doses.

Expect amphotericin B vials to be kept OUT of ADCs. Store ABLC and conventional drug in the fridge...but LAmB vials can be kept at room temp.

Apply labels to differentiate vials when storing...along with warning signs that the meds can’t be substituted.

Double-check the diluent when compounding IVs. Amphotericin B should ONLY be mixed with D5W. Apply an auxiliary sticker to remind nurses not to infuse with anything containing normal saline.

Be aware of differences in color. Lipid formulations are milky yellow...whereas conventional amphotericin B is a clear, dark yellow.

See our resource, Managing Candida Infections, for other antifungal treatment options.

• FAQ: Managing Candida Infections