## Amphotericin B Formulations and Nephrotoxicity **Key Point:** Liposomal amphotericin B (L-AmB) encapsulates the drug in liposomes, reducing binding to human cell membranes (especially renal tubular epithelium) while maintaining fungal selectivity. **High-Yield:** Liposomal formulation reduces nephrotoxicity by 50–70% compared to the deoxycholate form, making it the preferred formulation for patients with renal impairment or those requiring prolonged therapy. ## Amphotericin B Formulations Comparison | Formulation | Nephrotoxicity | Cost | Clinical Use | | --- | --- | --- | --- | | **Deoxycholate (conventional)** | **High** | Low | Limited to non-renal-impaired patients | | **Liposomal (L-AmB)** | **Low** | High | Preferred for renal disease, invasive infections | | **Lipid complex** | Moderate | Moderate | Alternative when cost is limiting | | **Colloidal dispersion** | Moderate | Moderate | Less commonly used | **Clinical Pearl:** The deoxycholate formulation causes acute tubular necrosis and electrolyte wasting (hypokalemia, hypomagnesemia); liposomal encapsulation preferentially delivers the drug to fungal cells and infected tissues while sparing renal tubules. **Mnemonic:** **LIPO** = **L**ess **I**njury to **P**roximal tubule **O**f kidney.
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