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Lipid Formulations for Amphotericin B: Does the Emperor Need New Clothes?

John R. Graybill, MD
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University of Texas Health Science Center at San Antonio, San Antonio, TX 78284 Requests for Reprints: John R. Graybill, MD, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(10):921-923. doi:10.7326/0003-4819-124-10-199605150-00011
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For many years, the polyene amphotericin B deoxycholate (AMBd) has been the emperor of systemic antifungal therapy. Unfortunately, the great efficacy of amphotericin B has been matched by substantial toxicity. Efforts to develop less toxic alternatives to AMBd have focused on repackaging amphotericin B in new clothes, that is, lipid vehicles. These vehicles have been designed to target sites of fungal infection but spare the kidneys [15]. In general, lipid-associated amphotericin B preparations achieve lower renal concentrations than does AMBd, and they are concentrated in reticuloendothelial tissues such as the liver and spleen. Pharmacokinetics variables, including tissue distribution and clearance, vary with the size, charge, amount, and type of lipid in the preparations.

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