Amphotericin B liposomal
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Infusion-related dystonia: case report A 30-year-old man developed infusion-related dystonia during treatment with amphotericin B liposomal for Candida glabrata fungaemia. The man with past medical history significant for recurrent episodes of Candida glabrata fungaemia, short bowel syndrome on total parenteral nutrition and an enterocutaneous fistula, presented to a hospital in the USA with blood cultures positive for Candida glabrata. Micafungin was started; however, susceptibility testing revealed resistance to voriconazole, micafungin and fluconazole. His treatment was then changed to amphotericin B liposomal [AmBisome] infusion 300mg (5 mg/kg) every 24 hours based on its better tolerability and safety profile as well as institutional formulary preference. No pre-medications were given before the initial administration. Ten minutes into the infusion, he developed a dystonic reaction characterised by excruciating pain and sustained muscle contractions, mainly in the middle to lower back. Notably, his laboratory tests were within normal limits and other medications were considered noncontributory. Because of the severity of the reaction, amphotericin B liposomal infusion was discontinued, and the man was treated with lorazepam, diphenhydramine and hydromorphone, leading to resolution of the symptoms. In view of limited alternative treatment options, the man was premedicated with lorazepam, diphenhydramine and hydromorphone and amphotericin B liposomal was resumed the following day. Additionally, the time of infusion was increased to 6 hours rather than the traditional 2 hours. One hour following the start of the second infusion, he developed a similar dystonic reaction. Therefore, the infusion was stopped again. At that time, the formulation was changed from amphotericin B liposomal to amphotericin B lipid complex [Abelcet] while maintaining the same pre-medications, dose and extended infusion time. After this formulation switch, no dystonic reactions were noted for the remainder of his treatment course. The Naranjo Adverse Drug Reaction Probability score was found to be 8, which indicated that amphotericin B liposomal [AmBisome] infusion was the probable cause of the dystonia. Lindquist DE, et al. Liposomal Amphotericin B Infusion-Related Dystonia. Annals of Pharmacotherapy 54: 1049-1050, No. 10, Oct 2020. Available from: URL: http:// 803499244 doi.org/10.1177/1060028020917632
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Reactions 5 Sep 2020 No. 1820
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