How Amphotericin B Works
Amphotericin B is a polyene antifungal. It binds to ergosterol, a building block of the fungal cell membrane, and forms pores that let the cell's contents leak out. This action targets common yeasts such as Candida species.
Why It Is Compounded as an Oral Rinse
A commercially made oral amphotericin B suspension is not generally available in the United States. When a prescriber wants this specific local antifungal, a compounding pharmacy can prepare it to order. An oral rinse keeps the medicine where it is needed — in the mouth — and because amphotericin B is poorly absorbed from the intestinal tract, most of the drug stays local, which lowers the chance of systemic (whole-body) exposure. Compounding also lets the prescriber set the strength, add flavoring to soften a famously bitter taste, and request sugar-free or dye-free versions for sensitive or high-risk patients. nih
How It Is Typically Used
Amphotericin B oral rinse is used as a "swish-and-spit" or "swish-and-swallow" preparation, on the schedule the prescriber sets. In a published clinical-trial protocol, a 100 mg/mL suspension was given as 5 mL swished and swallowed four times daily. Lippincott Williams & Wilkins
Clinical Context
Current Infectious Diseases Society of America (IDSA) guidelines include topical amphotericin B as a potential option for oropharyngeal candidiasis. It is often considered for patients such as those receiving chemotherapy or radiation, transplant recipients, people living with HIV, denture wearers, or patients on inhaled corticosteroids — when a provider judges a local antifungal appropriate. Evidence is mixed: one Adult AIDS Clinical Trials Group study found amphotericin B oral suspension well tolerated but of limited effectiveness for fluconazole-refractory oral candidiasis. Selection, dosing, and monitoring are always the prescriber's clinical decision. ResearchGate + 2
Quality and Compliance
Mixwell Compounding Pharmacy prepares this rinse in our purpose-built, USP <795>-compliant lab to the prescribing provider's exact instructions, dispensed only with a valid prescription. Mixwell is a non-sterile pharmacy and does not prepare sterile products or injectables; this is a topical oral rinse, not the intravenous form of amphotericin B. Compounded medications are not reviewed or approved by the FDA. Nothing here promises a specific result, and compounded preparations are not presented as superior to commercially available products.
References
- Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1–e50. doi:10.1093/cid/civ933.
- Adult AIDS Clinical Trials Group Study Team 295. Amphotericin B oral suspension for fluconazole-refractory oral candidiasis in persons with HIV infection. AIDS. 2000;14(7):845–852. PMID: 10839593.
- Professional Compounding Centers of America (PCCA). Formulation science and compounding resources. https://www.pccarx.com/Blog/