Skin & Appendages Skeletal Muscle Relaxants The overall therapeutic success rates for Amphotericin B liposome for injection and the Amphotericin B deoxycholate were equivalent. No formal clinical studies of drug interactions have been conducted with Amphotericin B liposome for injection; however, the following drugs are known to interact with Amphotericin B and may interact with Amphotericin B liposome for injection: The excretion of Amphotericin B after administration of Amphotericin B liposome for injection has not been studied. The existence of an effective, safe and inexpensive oral formulation of amphotericin B would have significant applications for the treatment of disseminated fungal infections and would dramatically expand access to treatment of visceral leishmaniasis by introducing a readily available highly tolerated oral formulation . 4. Serious side effects of Amphotericin b To decrease the likelihood and severity of the symptoms, initial doses should be low, and increased slowly. TTY Biopharm Company Limited LiouDu Factory The drug acts by binding to sterols (ergosterol) in the cell membrane of susceptible fungi. If this is not feasible, Amphotericin B liposome for injection must be administered through a separate line. Amphotericin B alone is insoluble in normal saline at a pH of 7. Intensive monitoring of renal function is recommended in patients requiring any combination of nephrotoxic medications. Even after I double checked the info in the link that I provided above that states NAHCo3 is compatibile with NS, you still made me second guess myself, so I called the pharmacist at the hospital. Amphotericin B molecules can form pores in the host membrane as well as the fungal membrane. [45], In addition, electrolyte imbalances such as hypokalemia and hypomagnesemia are also common. If Amphotericin B liposome for injection should be administered by intravenous infusion, using a controlled infusion device, over a period of approximately 120 minutes. Susceptibility Testing Packaged individually NDC 55150-365-01. Special Senses Aseptically add 12 mL of Sterile Water for Injection, USP to each Amphotericin B liposome for injection vial to yield a preparation containing 4 mg Amphotericin B/mL. Amphotericin B was studied in patients with visceral leishmaniasis who were infected in the Mediterranean basin with documented or presumed Leishmania infantum. Maybe it just depends on the facility's policy. Verify the product name and dosage pre-administration, especially if dose exceeds 1.5 mg/kg. Should RaDonda Vaught Have Her Nursing License Reinstated? Day 1 body temperature increased above the temperature taken within 1 hour prior to infusion (preinfusion temperature) or above the lowest infusion value (no preinfusion temperature recorded). Amphotericin B is an antifungal medication that fights infections caused by fungus. Experience with Amphotericin B liposome for injection in the elderly (65 years or older) comprised 72 patients. over 4 hr 3/week for 10 weeks) was assessed in two groups often . 2022 Jan-Feb;25(1):7-10. doi: 10.4103/aian.AIAN_421_21. Amphotericin B is associated with renal insufficiency, hypokalemia, hypomagnesemia, hypocalcemia, and hypophosphatemia. [57] The first synthesis of the compound's naturally occurring enantiomeric form was achieved in 1987 by K. C. Skin reactions, including serious forms, are also possible. CAUTION: DO NOT RECONSTITUTE WITH SALINE OR ADD SALINE TO THE RECONSTITUTED CONCENTRATION, OR MIX WITH OTHER DRUGS. Digitalis Glycosides Amphotericin B liposome for injection and Amphotericin B were found to be equivalent with respect to the total number of emergent fungal infections. A negative value is in favor of Amphotericin B. [citation needed], Drug-drug interactions may occur when Amphorectin B is coadministered with the following agents:[47], Amphotericin B binds with ergosterol, a component of fungal cell membranes, forming pores that cause rapid leakage of monovalent ions (K+, Na+, H+ and Cl) and subsequent fungal cell death. Leukocyte Transfusions In rats, the maternal non-toxic dose of Amphotericin B liposome for injection was estimated to be 5 mg/kg (equivalent to 0.16 to 0.8 times the recommended human clinical dose range of 1 to 5 mg/kg) and in rabbits, 3 mg/kg (equivalent to 0.2 to 1 times the recommended human clinical dose range), based on body surface area correction. Agitation, coma, convulsion, cough, depression, dysesthesia, dizziness, hallucinations, nervousness, paresthesia, somnolence, thinking abnormality, and tremor. Has 3 years experience. [46] In the liver, increased liver enzymes and hepatotoxicity (up to and including fulminant liver failure) are common. Arthralgia, bone pain, dystonia, myalgia, and rigors. Efficacy is expressed as both acute parasite clearance at the end of therapy (EOT) and as overall success (clearance with no relapse) during the follow-up period (F/U) of greater than 6 months for immunocompetent and immunocompromised patients: When followed for 6 months or more after treatment, the overall success rate among immunocompetent patients was 96.5% and the overall success rate among immunocompromised patients was 11.8% due to relapse in the majority of patients. Mycologically-confirmed fungal infections at study entry were cured in 8 of 11 patients in the Amphotericin B liposome for injection group and 7 of 10 in the Amphotericin B group. Immediately after the addition of water, SHAKE THE VIAL VIGOROUSLY, TTY Biopharm Company Limited LiouDu Factory. Amphotericin B injection can cause serious side effects. We comply with the HONcode standard for trustworthy health information. Each carton contains one pre-packaged, disposable sterile 5 micron filter. All brands listed are the trademarks of their respective owners and are not trademarks of Eugia Pharma Specialities Limited. Amphotericin B and azoles have been tested and shown to be effective . Oddly enough as I searched the web for info I came across a drug "lovers" site. Within each module, the extender units are loaded onto the current ACP domain by acetyl transferase (AT). [42][43] The integrity of the liposome is disrupted when it binds to the fungal cell wall, but is not affected by the mammalian cell membrane,[44] so the association with liposomes decreases the exposure of the kidneys to amphotericin B, which explains its less nephrotoxic effects. The site is secure. Flucytosine. Amphotericin B liposome for injection did not affect fertility or days to copulation. Amphotericin B is capable of forming channels in membranes. Amphotericin B is an antifungal medication used for serious fungal infections and leishmaniasis. Amphotericin B liposome for injection must be diluted with 5% Dextrose Injection to a final concentration of 1 to 2 mg/mL prior to administration. Amphotericin B Liposome for Injection 50 mg per Vial For Intravenous Infusion Only Amphotericin B Liposome for Injection is Such differences may affect the functional properties of these drug products. Your doctor may give you a smaller dose first to test your response to the medication. Three controlled empirical therapy trials compared the efficacy and safety of Amphotericin B liposome for injection to Amphotericin B. 1-917-426-3524, By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. The pharmacokinetic profile of Amphotericin B after administration of Amphotericin B liposome for injection is based upon total serum concentrations of Amphotericin B. Azoles (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.) Conjunctivitis, dry eyes, and eye hemorrhage. However, adverse effects are common, with nephrotoxicity being the most serious, occurring early in the course of treatment, and usually being reversible in most patients. For immunocompromised patients who do not clear parasites or who experience relapses, expert advice regarding further treatment is recommended. The assay used to measure Amphotericin B in the serum after administration of Amphotericin B liposome for injection does not distinguish Amphotericin B that is complexed with the phospholipids of Amphotericin B liposome for injection from Amphotericin B that is uncomplexed. AmBisome is NOT compatible with saline and Metabolic & Nutritional Disorders Amphotericin B is a polyene antibiotic that can increase the permeability of lipid bilayers and cell membranes to polar solutes.15 Amphotericin B can be extracted from S. nodosus. * 97.5% Confidence Interval for the difference between Amphotericin B liposome for injection and Amphotericin B rates. [28] It consists of amphotericin B and two lipids in a 1:1 ratio that form large ribbon-like structures. The manufacturer recommends beginning intravenous therapy with a 1-mg test dose. Faculty of Chemistry, Gdnsk University of Technology. The incidence of mycologically-confirmed, and clinically-diagnosed, emergent fungal infections are presented in the following table. Nicolaou. Abnormal renal function, acute kidney failure, acute renal failure, dysuria, kidney failure, toxic nephropathy, urinary incontinence, and vaginal hemorrhage. This clinical program included both controlled and uncontrolled studies. Clipboard, Search History, and several other advanced features are temporarily unavailable. The effect of Amphotericin B liposome for injection on renal and hepatic function and on serum electrolytes was assessed from laboratory values measured repeatedly in Study 94-0-002. http://www.vhpharmsci.com/PDTM/Monographs/sodium_bicarbonate.htm. Bladder instillation of amphotericin B 50 mg in 1 L of sterile water has been used to treat fungal cystitis. Adverse Drug Reaction of Antifungals in the Management of Black Fungus: A Tertiary Care Centre Experience. Even after I double checked the info in the link that I provided above that states NAHCo3 is compatibile with NS, you still made me second guess myself, so I called the pharmacist at the hospital. Nineteen hundred and forty-six (1,946) episodes were evaluable for efficacy, of which 1,280 (302 pediatric and 978 adults) were treated with Amphotericin B. Amphotericin B liposome for injection has not been tested to determine its mutagenic potential. Amphotericin B liposome for injection consists of these unilamellar bilayer liposomes with Amphotericin B intercalated within the membrane. Following induction, all patients were switched to oral fluconazole at 400 mg/day for adults and 200 mg/day for patients less than 13 years of age to complete 10 weeks of protocol-directed therapy. For mycologically evaluable patients, defined as all randomized patients who received at least one dose of study drug, had a positive baseline CSF culture, and had at least one follow-up culture, success was evaluated at week 2 (i.e., 14 4 days), and was defined as CSF culture conversion. Then add 1ml amphotericin to 49 ml 5% dextrose to give a final solution of amphotericin 0.1 mg/ml. Amphotericin B liposome for injection must be reconstituted using Sterile Water for Injection, USP (without a bacteriostatic agent). He confirmed Sodium Bicarb is compatible with normal saline. The incidence of infusion-related, cardiovascular and renal adverse events was lower in patients receiving Amphotericin B liposome for injection compared to Amphotericin B deoxycholate (see ADVERSE REACTIONS section for details); therefore, the risks and benefits (advantages and disadvantages) of the different Amphotericin B formulations should be taken into consideration when selecting a patient treatment regimen. [50] Researchers have found evidence that amphotericin B also causes oxidative stress within the fungal cell,[51] but it remains unclear to what extent this oxidative damage contributes to the drug's effectiveness. Hepatic Impairment Safety and effectiveness in pediatric patients below the age of one month have not been established (See DESCRIPTION OF CLINICAL STUDIES - Empirical Therapy in Febrile Neutropenic Patients and DOSAGE AND ADMINISTRATION). Systemic fungal infections have been successfully treated in pregnant women with Amphotericin B deoxycholate, but the number of cases reported has been small. One compassionate use study enrolled patients who had failed Amphotericin B deoxycholate therapy or who were unable to receive Amphotericin B deoxycholate because of renal insufficiency. Incidence of nephrotoxicity, mean peak serum creatinine concentration, mean change from baseline in serum creatinine, and incidence of hypokalemia in the double-blind, randomized study were lower in the Amphotericin B liposome for injection group as summarized in the following table: The effect of Amphotericin B liposome for injection (3 mg/kg/day) vs. Amphotericin B (0.6 mg/kg/day) on renal function in adult patients enrolled in this study is illustrated in the following figure: Lower concentrations (0.2 to 0.5 mg/mL) may be appropriate for infants and small children to provide sufficient volume for infusion. When administered concomitantly, serum potassium levels should be closely monitored. Manufactured by: If this is not feasible, Amphotericin B liposome for injection must be administered through a separate line. I was pondering what normal saline is not compatible with. Unrestricted Indications 1) Documented or suspected fungal pneumonia in a patient intolerant of or with contraindications to azoles 2) Prophylaxis . Anaphylaxis has been reported with Amphotericin B deoxycholate and other Amphotericin B-containing drugs, including Amphotericin B liposome for injection. Combination therapy should be administered with caution, especially in immunocompromised patients. It is not stable with any dextrose. For decades it remained the only effective therapy for invasive fungal disease until the development of the azole antifungals in the early 1980s. The order of these three post-cyclization processes is unknown. The use of any solution other than those recommended, or the presence of a bacteriostatic agent in the solution, may cause precipitation of Amphotericin B liposome for injection. As they discussed the ways to manage diazepam, cooking, snorting, SL etc they said it is only "slightly" soluble in alcohol, and not at all in NS. [29] The amphipathic nature of amphotericin along with its low solubility and permeability has posed major hurdles for oral administration given its low bioavailability. Patients were not administered premedications to prevent infusion-related reactions prior to the Day 1 study drug infusion. For additional information, see DESCRIPTION OF CLINICAL STUDIES. Concurrent use of flucytosine may increase the toxicity of flucytosine by possibly increasing its cellular uptake and/or impairing its renal excretion. One hundred and sixty-six (166) patients received Amphotericin B liposome for injection (85 patients received 3 mg/kg/day and 81 received 5 mg/kg/day) and 78 patients received Amphotericin B lipid complex. Has 15 years experience. Amphotericin B liposome for injection forms a yellow translucent suspension. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Maybe it just depends on the facility's policy. Mitrano FP, Outman WR, Baptista RJ, Palombo JD. Aspergillus fumigatus, Aspergillus flavus, Candida albicans, Candida krusei, Candida lusitaniae, Candida parapsilosis, Candida tropicalis, Cryptococcus neoformans, (e.g., ketoconazole, miconazole, clotrimazole, fluconazole, etc.). In studies which included 302 pediatric patients administered Amphotericin B liposome for injection, there was no evidence of any differences in efficacy or safety of Amphotericin B liposome for injection compared to adults. This is because amphotericin B resistance requires sacrifices on the part of the pathogen that make it susceptible to the host environment, and too weak to cause infection. Last updated on Nov 1, 2022. It forms transmembrane channels leading to alterations in cell permeability through which monovalent ions (NA+, K+, H+, and Cl-) leak out of the cell resulting in cell death. FUNGIZONE (amphotericin b) Intravenous is specifically intended to treat potentially life-threatening fungal infections: aspergillosis, cryptococcosis (torulosis), North American blastomycosis, systemic candidiasis, coccidioido-mycosis, histoplasmosis, zygomycosis including mucormycosis due to susceptible species of . Delta remains as the most virulent SARS-CoV-2 variant. [56] [4] It is in the polyene class of medications and works in part by interfering with the cell membrane of the fungus. Is amphotericin B Fungistatic or fungicidal? Single-Dose Vial, Rx only NDC 55150-365-01 [5] Abelcet was approved by the FDA in 1995. A positive value is in favor of Amphotericin B liposome for injection. Amphotericin B liposome for injection and Amphotericin B lipid complex were infused over two hours. Amphotericin B Liposome for Injection 50 mg per Vial For Intravenous Infusion Only Amphotericin B Liposome for Amphotericin B has a molecular formula of C47H73NO17 and a molecular weight of 924.08 g/mol. Is AmBisome compatible with saline? IV Fluids: Give 500mL Normal Saline before and after AmBisome administration if able to tolerate. Has 16 years experience. Liposomes are closed, spherical vesicles created by mixing specific proportions of amphophilic substances such as phospholipids and cholesterol so that they arrange themselves into multiple concentric bilayer membranes when hydrated in aqueous solutions. Inject the syringe contents through the filter, into the appropriate amount of 5% Dextrose Injection (use only one filter per vial of Amphotericin B liposome for injection). [20], The original formulation uses sodium deoxycholate to improve solubility. The latter formulations have been developed to improve tolerability and decrease toxicity, but may show considerably different pharmacokinetic characteristics compared to conventional amphotericin B. [22], In order to improve the tolerability of amphotericin and reduce toxicity, several lipid formulations have been developed. Our members represent more than 60 professional nursing specialties. J. Czub, M. Baginski. Although severe noninfectious panophthalmitis resulted in every case, the visual acuity outcomes were good. Physicians should examine the color of amphotericin B solution prior to intraocular administration. This therapeutic equivalence had no apparent relationship to the use of prestudy antifungal prophylaxis or concomitant granulocytic colony-stimulating factors. PMC Dilantin actually requires a flush with NS before and after if giving in an IV that has D5W infusing. I think it may be a viscosity/solubility thing. How do you prepare an amphotericin B injection? Amphotericin B is an antifungal medication used for serious fungal infections and leishmaniasis. Specializes in onc, M/S, hospice, nursing informatics. However, based on total Amphotericin B concentration measured up to 49 days after dosing of Amphotericin B liposome for injection, the mean half-life was 100 to 153 hours. However, Amphotericin B liposome for injection has been successfully administered to patients with pre-existing renal impairment (see DESCRIPTION OF CLINICAL STUDIES). Concurrent use of corticosteroids and ACTH may potentiate hypokalemia, which could predispose the patient to cardiac dysfunction. This site needs JavaScript to work properly. It offers potent, broad-spectrum antifungal activity but is associated with significant renal toxicity and infusion reactions. Before Different Amphotericin B products are not equivalent in terms of pharmacodynamics, pharmacokinetics and dosing. Lipid formulations of amphotericin B are extremely expensive. Amphotericin B liposome for injection is pale yellow to yellow lyophilized product, available as single cartons. Elderly Patients . The following adverse events also have been reported in 2% to 10% of Amphotericin B liposome for injection-treated patients receiving chemotherapy or bone marrow transplantation, or who had HIV disease in six comparative, clinical trials: 8600 Rockville Pike However, the liposomal amphotericin B treatment group had fewer proven fungal infections, fewer infusion-related side effects and less nephrotoxicity. Acute kidney injury (AKI) is a relatively common complication of amphotericin B deoxycholate, as are other kidney manifestations, including urinary potassium wasting and hypokalemia, urinary magnesium wasting and hypomagnesemia, metabolic acidosis due to type 1 . Antifungal and antiparasitaric Chemical compound, O=C(O)[C@@H]3[C@@H](O)C[C@@]2(O)C[C@@H](O)C[C@@H](O)[C@H](O)CC[C@@H](O)C[C@@H](O)CC(=O)O[C@@H](C)[C@H](C)[C@H](O)[C@@H](C)C=CC=CC=CC=CC=CC=CC=C[C@H](O[C@@H]1O[C@H](C)[C@@H](O)[C@H](N)[C@@H]1O)C[C@@H]3O2, InChI=1S/C47H73NO17/c1-27-17-15-13-11-9-7-5-6-8-10-12-14-16-18-34(64-46-44(58)41(48)43(57)30(4)63-46)24-38-40(45(59)60)37(54)26-47(61,65-38)25-33(51)22-36(53)35(52)20-19-31(49)21-32(50)23-39(55)62-29(3)28(2)42(27)56/h5-18,27-38,40-44,46,49-54,56-58,61H,19-26,48H2,1-4H3,(H,59,60)/b6-5+,9-7+,10-8+,13-11+,14-12+,17-15+,18-16+/t27-,28-,29-,30+,31+,32+,33-,34-,35+,36+,37-,38-,40+,41-,42+,43+,44-,46-,47+/m0/s1. This medication is usually given by injection into a vein as directed by your doctor, usually once a day. The structure of Amphotericin B is shown below: Mechanism of Action In empirical therapy study 97-0-034, a greater proportion of patients in the Amphotericin B lipid complex group discontinued the study drug due to an adverse event than in the Amphotericin B liposome for injection groups. For specific information regarding susceptibility test interpretive criteria and associated test methods and quality control standards recognized by FDA for this drug, please see: https://www.fda.gov/STIC. This nearly universal febrile response necessitates a critical (and diagnostically difficult) professional determination as to whether the onset of high fever is a novel symptom of a fast-progressing disease, or merely the effect of the drug. Distributed by: Study 94-0-002, a randomized, double-blind, comparative multi-center trial, evaluated the efficacy of Amphotericin B liposome for injection (1.5 to 6 mg/kg/day) compared with Amphotericin B deoxycholate (0.3 to 1.2 mg/kg/day) in the empirical treatment of 687 adult and pediatric neutropenic patients who were febrile despite having received at least 96 hours of broad spectrum antibacterial therapy. 1998 Jan-Feb;25(1):35-48. Prospective surveillance of intravenous amphotericin B use patterns. The primary endpoint of this study was safety. Withdraw this amount of reconstituted Amphotericin B liposome for injection into a sterile syringe. Sodium Bicarbonate-always mix that with D5W. In pediatric patients (16 years of age or less) in this double-blind study, Amphotericin B liposome for injection compared to Amphotericin B deoxycholate, had a lower incidence of hypokalemia (37% versus 55%), chills (29% versus 68%), vomiting (27% versus 55%), and hypertension (10% versus 21%). How to use Amphotericin B Vial. National Library of Medicine Syringe pump infusion over six to eight hours . Amphotericin B was fungicidal (MFC/MIC 4) against all A. fumigatus and A. flavus isolates but no A. terreus isolates, whereas voriconazole was fungicidal against 82% of A. In Study 94-0-002, a significantly lower incidence of grade 3 or 4 toxicity was observed in the Amphotericin B liposome for injection group compared with the Amphotericin B group. In every case, the overly concentrated amphotericin B solution was yellow in color. Amphotericin B liposome for injection is not interchangeable or substitutable on a mg per mg basis with other Amphotericin B products. Antimicrobial Activity 1. Unopened vials of lyophilized material are to be stored at temperatures up to 25 C (77 F). Treatment of Cryptococcal Meningitis in HIV-infected patients (see, Treatment of visceral leishmaniasis. Create well-written care plans that meets your patient's health goals. [27] It is marketed by Gilead in Europe and licensed to Astellas Pharma (formerly Fujisawa Pharmaceuticals) for marketing in the US, and Sumitomo Pharmaceuticals in Japan. Therapeutic success required (a) resolution of fever during the neutropenic period, (b) absence of an emergent fungal infection, (c) patient survival for at least 7 days post therapy, (d) no discontinuation of therapy due to toxicity or lack of efficacy, and (e) resolution of any study-entry fungal infection. [19] Lipid-based formulations of amphotericin B are no more effective than conventional formulations, although there is some evidence that lipid-based formulations may be better tolerated by patients and may have fewer adverse effects. Either that or a certain hospital in my neck of the woods is NOT helping a lot of people when they hang their Bicarb drips. Both studies support the efficacy equivalence of Amphotericin B liposome for injection and Amphotericin B as empirical therapy in febrile neutropenic patients. J Code (medical billing code): J0289 (10 mg, injection). Specializes in Hospice. Gender and Ethnicity Do not use amphotericin B in larger amounts than recommended. This impairment in membrane barrier function can have lethal effects. An in-line membrane filter may be used for the intravenous infusion of Amphotericin B liposome for injection, provided THE MEAN PORE DIAMETER OF THE FILTER IS NOT LESS THAN 1.0 MICRON. Concurrent use of Amphotericin B and other nephrotoxic medications may enhance the potential for drug-induced renal toxicity. Revised: September 2022, Rx only NDC 55150-365-01 2022. [5] It is typically given intravenously (injection into a vein). Christine D. Waugh, in xPharm: The Comprehensive Pharmacology Reference, 2007. Amphotericin B liposome for injection is a true single bilayer liposomal drug delivery system. used in Beckman Coulter analyzers including the Synchron LX20). Why must amphotericin B be given intravenously? 3 (2017): 146-154. Less kidney toxicity has been reported with liposomal formulations (such as AmBisome) and it has become preferred in patients with preexisting renal injury. The incidence of adverse events occurring in more than 10% of subjects in one or more arms regardless of relationship to study drug are summarized in the following table: Infusion-Related Reactions Clinical success and mycological eradication occurred in some patients with documented aspergillosis, candidiasis, and cryptococcosis. Aseptically add 12 mL of Sterile Water for Injection, USP to each AmBisome vial to yield a preparation containing 4 mg amphotericin B/mL. Amphotericin B is used to treat serious, life-threatening fungal infections. Here, we studied the morphology of Delta virions from both paraformaldehyde (PFA) and electron beam inactivated samples and determined . The manufacturer recommends beginning intravenous therapy with a 1-mg test dose. Hemic & Lymphatic System [4] For certain infections it is given with flucytosine. Amphotericin B, an effective but relatively toxic drug, has long been the mainstay of antifungal therapy for invasive and serious mycoses. [4], Common side effects include a reaction with fever, chills, and headaches soon after the medication is given, as well as kidney problems. AmBisome is NOT compatible with saline and must not be reconstituted or diluted with saline or administered through an intravenous line that has previously been used for saline unless first flushed with dextrose solution (5%, 10% or 20%) for infusion. Propofol dripsat least at our hospital. The carbon chains of Amphotericin B are assembled from sixteen 'C2' acetate and three 'C3'propionate units by polyketide syntheses (PKSs). Pediatric patients appear to have more tolerance than older individuals for the nephrotoxic effects of Amphotericin B deoxycholate. Do not freeze. The growing chain is constructed by a series of Claisen reactions. Empirical Therapy in Febrile Neutropenic Patients The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). DISCARD PARTIALLY USED VIALS. It is not for use in treating a minor fungal infection (yeast infection) of the mouth, esophagus, or vagina. It is active against clinically relevant yeasts and moulds, including Candida spp., Aspergillus spp. Before taking this medicine I know of just 2 medications that are NOT compatible with normal saline: amphotericin B (for fungal infections) and GM-CSF (Sargramostim) to stimulate granulocytes and macrophages in oncology patients and HIV patients.