Limited Toxicity of Prolonged Therapy with High Doses of Amphotericin B Lipid Complex

We describe six patients with invasive fungal infections who received large cumulative doses (22.3-73.6 g) of amphotericin B lipid complex (ABLC) over 21-121 weeks. The drug was well tolerated at these very large doses, and there was limited toxicity. Collectively, these patients received ABLC therapy for a mean of 53.8 weeks (range, 21-121 weeks). The mean serum creatinine level at the start of ABLC therapy was 1 mg/dL (range, 0.4-1.9 mg/dL), and at the end of therapy this level was 1.5 mg/dL (range, 1.0-2.0 mg/dL). Over the course of therapy, only two patients had serum creatinine levels of ≥2 mg/dL, with transient peak serum creatinine levels of 3.5 and 2.8 mg/dL, respectively. Several patients required replacement therapy with oral or intravenous potassium. None of the patients had ABLC-associated toxic effects necessitating discontinuation of the treatment. ABLC may be given in substantially larger doses than conventional amphotericin B, and very high doses of ABLC that are administered over several months appear to be relatively less toxic than those of conventional amphotericin B.