Common adverse effects which occur during or after intravenous infusion of amphotericin B include headache, nausea, vomiting, chills, fever, malaise, muscle and joint pains, anorexia, diarrhea, and gastrointestinal cramp. Hypertension, hypotension, cardiac arrhythmias including ventricular fibrillation and cardiac arrest, skin rashes, flushing, anaphylactoid reactions including bronchospasm and dyspnoea, blurred vision, tinnitus, hearing loss, vertigo, gastrointestinal bleeding, liver disorders, peripheral neuropathy, and convulsions have been reported occasionally. Some degree of nephrotoxicity occurs in almost all patients given amphotericin B intravenously.
Both tubular and glomerular damage occur; there may be improvement on cessation of therapy, but there is a risk of permanent renal impairment, particularly in patients given large cumulative doses (over 5 g). Renal tubular acidosis without systemic acidosis may develop. Use of amphotericin B is associated with increased urinary excretion of potassium and magnesium resulting in hypokalaemia and hypomagnesaemia respectively. Uric acid excretion is increased and nephrocalcinosis can occur. Reversible, normocytic, normochromic anemia develops in most patients given amphotericin B, possibly due to a direct suppressive
effect on erythropoietin production. There are rare reports of thrombocytopenia, leucopenia, agranulocytosis, eosinophilia, and coagulation defects. Leukoencephalopathy has been reported rarely in patients also receiving total body irradiation. Amphotericin B solutions irritate the venous endothelium and may cause pain and thrombophlebitis at the injection site. Extravasation may cause tissue damage. After intrathecal injection amphotericin B may also cause irritation of the meninges, neuropathy with pain, impaired vision, and retention of urine. In general, adverse effects of lipid formulations have been similar to those of conventional amphotericin B, but are less frequent and less severe. Brief reversible episodes of
renal impairment have been observed but these formulations have been considered to be safe enough to use in patients with renal impairment who could not be given conventional amphotericin B. Anaphylaxis has been reported rarely.