deoxycholic-acid and Drug-Overdose

To report a case of accidental amphotericin B overdose that was treated with plasmapheresis.. A 60-year-old woman with a history of kidney transplant 4 years prior to presentation for a congenital abnormality was admitted for a suspected systemic fungal infection. The patient inadvertently received intravenous amphotericin B deoxycholate 250 mg (4.3 mg/kg) over 2 hours instead of prescribed liposomal amphotericin B. The medication error was discovered 16 hours after administration. She had normal vital signs at that time and reported abdominal pain and general malaise. Results of a metabolic panel were significant for a creatinine level of 2.1 mg/dL and CO₂ of 17 mg/dL. Her serum amphotericin B concentration 33 hours after the initial dose was 4.9 μg/mL. She subsequently received 5 courses of plasmapheresis and 3 courses of hemodialysis and ultimately did not develop any further renal injury, as well as hemolysis, cardiovascular collapse, dysrhythmias, or severe electrolyte abnormalities.. The dosing differences between nonliposomal and liposomal preparations of amphotericin B can be as high as 50-fold. Reported adverse events from overdose in both animal models and human case reports include renal insufficiency, hemolysis, thrombocytopenia, electrolyte abnormality, and cardiac dysrhythmias. There have been previous reports of similar errors that have led to death. Furthermore, amphotericin B has been shown to be poorly dialyzable. Our patient's serum amphotericin B concentration decreased after she received plasmapheresis, and she did not develop severe complications.. We describe a patient who survived a 4-fold overdose of amphotericin B because of a medication error. The use of plasmapheresis may have enhanced the elimination of amphotericin B and may have contributed to the positive outcome. However, the role of plasmapheresis in amphotericin overdose is not fully understood.

Topics: Amphotericin B; Antifungal Agents; Deoxycholic Acid; Drug Combinations; Drug Overdose; Female; Humans; Immunocompromised Host; Infusions, Intravenous; Kidney Transplantation; Medication Errors; Middle Aged; Mycoses; Plasmapheresis; Renal Dialysis; Treatment Outcome

Due to the similarity of their generic names, the use of amphotericin B-deoxycholate and liposomal amphotericin B could cause confusion in daily practice. We report two cases of amphotericin B-deoxycholate overdose in infants due to administration errors which raises the issue that the use of this antifungal agent should be questioned because of its severe side effects.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Chemistry, Pharmaceutical; Deoxycholic Acid; Drug Combinations; Drug Overdose; Fatal Outcome; Humans; Infant; Medication Errors

To report the clinical course of a woman with cryptococcal meningitis and no previous cardiac disease who developed a fatal cardiac arrhythmia after an acute overdose of amphotericin B and to review its toxicity.. A 41-year-old woman with a history of proliferative glomerulonephritis from systemic lupus erythematosus was admitted with a diagnosis of cryptococcal meningitis. Liposomal amphotericin B was prescribed at the standard dose of 5 mg/kg/day; however, amphotericin B deoxycholate 5 mg/kg was inadvertently administered (usual dose of the deoxycholate formulation is 0.5-0.8 mg/kg/day). The patient developed cardiac arrhythmias, acute renal failure, and anemia. The medication error was noticed after she had received 2 doses of amphotericin B deoxycholate, and it was then discontinued. Despite treatment in the intensive care unit, the woman died on the sixth day after admission.. Amphotericin B deoxycholate has been reported to produce significant cardiac toxicity, with ventricular arrhythmias and bradycardia reported in overdoses in children and in adults with preexisting cardiac disease, even when administered in conventional dosages and infusion rates. Use of the Naranjo probability scale indicated a highly probable relationship between the observed cardiac toxicity and amphotericin B deoxycholate therapy in this patient.. Given the fulminant course of amphotericin B deoxycholate overdosage and lack of effective therapy, stringent safeguards against its improper administration should be in place.

Topics: Acute Disease; Adult; Amphotericin B; Arrhythmias, Cardiac; Chemistry, Pharmaceutical; Deoxycholic Acid; Drug Combinations; Drug Overdose; Fatal Outcome; Female; Humans; Medication Errors; Meningitis, Cryptococcal

The toxicity of amphotericin B deoxycholate has led to increased preference for lipid formulations with more favorable safety profiles. However, the primary use of lipid formulations is cost prohibitive, and many hospital formularies list both lipid and nonlipid formulations. A dispensing and administration error that caused amphotericin B deoxycholate to be given instead of liposomal amphotericin B related in a fatality. Measures to prevent confusion and aid in understanding the differences between lipid and nonlipid formulations of amphotericin B should be implemented.

Topics: Adult; Amphotericin B; Antifungal Agents; Chemistry, Pharmaceutical; Deoxycholic Acid; Drug Combinations; Drug Overdose; Fatal Outcome; Female; Humans; Liposomes; Medication Errors; Meningitis, Cryptococcal