Amphotericin B Liposomal (Tillomed/Gilead/AmBisome)

Standard dose: 3-5mg/kg iv od

For severe infection e.g. mucormycosis: Micro/ID may recommend doses greater than 5mg/kg.

Note: For haemato-oncology patients see management and prevention of invasive fungal infection (IFI) in adult haemato-oncology patients guideline

Discuss with pharmacy

Renal impairment

No dose adjustment necessary.

• Monitor renal function and electrolytes including potassium before starting treatment and then regularly during course of treatment.
• If clinically significant reduction in renal function or worsening of other parameters occurs, consideration should be given to dose reduction, treatment interruption or discontinuation 

Hepatic impairment

No information available regarding dosing in hepatic impairment. No dose adjustment recommended. Monitor for side effects.

Before amphotericin B liposomal is started see Summary of Product Characteristics (SPC) for amphotericin B liposomal for information about interactions, cautions and contraindications. 

Pregnancy

Manufacturers advise use only where benefit to mother outweigh risks to foetus.

Breastfeeding

Discuss with pharmacy. There is no data about use in breastfeeding. Amphotericin B is a large, highly protein bound molecule

• Patient MUST be monitored during each dose for anaphylactic reactions or hypersensitivity reactions.

• • January 2025 - A test dose is no longer recommended by the manufacturers because anaphylaxis and anaphylactoid reactions can occur at any point of treatment therefore the patient should be monitored closely during each dose.

• See Medusa injectable monograph for administration information.

• When making up a dose do not mix the Tillomed and Gilead preparations. A dose must be made using products from same manufacturer.

• Monitor renal function, electrolytes (especially potassium and magnesium), FBCs and LFTs before and during treatment.

• Amphotericin B liposomal (Tillomed/Gilead/AmBisome) must be prescribed using the EPR order sentence or relevant powerplan. There is a risk of potentially fatal adverse reactions if formulations of amphotericin B are confused - see amphotericin B liposomal MHRA Drug Safety Updates

• Amphotericin B liposomal (Tillomed and Gilead) preparations contain approximately 900 mg of sucrose in each vial. This should be taken into account when treating diabetic patients. 

• The OUH Antifungal Patient Information Leaflet can be found HERE

• Tillomed Laboratories Ltd. Summary of product characteristics. Amphotericin B Tillomed liposomal 50 mg powder for dispersion for infusion. [on-line]. Last revision of the text: 5/11/24. Accessed via www.medicines.org.uk Accessed 12/5/25
• Gilead Sciences Ltd. Summary of product characteristics. Amphotericin B Gilead liposomal 50 mg Powder for dispersion for infusion (previously known as AmBisome). [on-line] Last revision of the text: 3/2/25. Accessed via www.medicines.org.uk Accessed 12/5/25

• The Renal Drug Database. Amphotericin IV- Ambisome (liposomal). [online]. Last updated10/5/23. Accessed via  https://renaldrugdatabase.com Accessed 12/5/25

• BNF online accessed via www.medicinescomplete.com Accessed 12/5/25  

• Sanford Guide. Amphotericin B [Internet] Last revision of the text: 7/4/25. Accessed via https://webedition.sanfordguide.com Accessed 12/5/25

• Sanford Guide. Obesity dosing adjustment [Internet] Last revision of the text: 25/4/25.  Accessed via https://webedition.sanfordguide.com Accessed 12/5/25

• LactMed - Amphotericin B. [online]. Last revision of the text 17/3/21. Accessed via: www.ncbi.nlm.nih.gov Accessed 12/5/25

• MHRA. Drug Safety update (July 2020) Liposomal and lipid-complex formulations: name change to reduce medication errors. Accessed at https://www.gov.uk/drug-safety-update/liposomal-and-lipid-complex-formulations-name-change-to-reduce-medication-errors
• MHRA. Drug Safety update (July 2018) Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused. Accessed at https://www.gov.uk/drug-safety-update/parenteral-amphotericin-b-reminder-of-risk-of-potentially-fatal-adverse-reaction-if-formulations-confused