Amphotericin B
Another group of antimycotics (fungicides) are polyenes. With the active ingredients Amphotericin B (Amphotericin B®), Nystatin (Moronal®) or Natamycin (Pimafucin®), the point of attack is also at the cell membrane of the fungi. Among other things, the cell membrane protects against the exchange of charged particles (ions, electrolytes) between the cell interior and the environment.
The interaction with the membrane leads to the formation of channels. The consequence is an uncontrolled exchange of electrolytes with disturbance of the cell function, which in the case of Amphotericin B causes a killing (fungicidal effect) and in the case of Natamycin an inhibition of growth (fungistatic effect) of the fungi (remedy against fungal diseases). Use, side effects and contraindications: Amphotericin B can be administered only as an infusion, as it is not absorbed into the bloodstream by the gastrointestinal tract when administered orally.
It works well against a wide range of different fungi. However, as it may damage kidneys (nephrotoxic) and is excreted slowly by the kidneys, it is used only in severe, life-threatening fungal infections. Sometimes an inflammation of the vein at the point where the infusion needle is inserted (thrombophlebitis).
Other side effects may include fever and other flu-like symptoms. In addition to disorders of the gastrointestinal tract, the composition of blood components can also change, especially a reduced platelet count (thrombocytopenia), which has an effect on the blood’s ability to clot. Therefore, Amphotericin B should not be used for liver and kidney diseases and their function and blood values should be checked regularly during treatment.
In the case of intolerance, it is possible to use liposomal Amphotericin B, an active substance packed in fats, so to speak. With the same efficacy, the lipid formulation shows significantly fewer side effects (anti-fungal agents). Drug-drug interactions: Also with Amphotericin B, interactions occur when certain other drugs are administered simultaneously. For example, Amphotericin B enhances the effect of certain cardiac drugs (cardiac glycosides), muscle relaxants (muscle relaxants) and drugs for cardiac arrhythmia (antiarrhythmics). Furthermore, the kidney-damaging effect of other kidney-damaging drugs is enhanced.
