Amphotericin B Oral Suspension (SuspendIt®)

Oral Suspension Vehicle

A compounded amphotericin B oral suspension in SuspendIt, prepared in Chino, CA to a prescriber's order, since the approved product was discontinued.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

USP <795> compliant
USP <800> hazardous drug lab
PCCA member

At a Glance

Preparation details for Amphotericin B Oral Suspension (SuspendIt®)
Dosage form	Oral suspension
Route	Oral
Active ingredients	Amphotericin B
Technology	Oral Suspension Vehicle
Strengths in literature	Amphotericin B 100 mg/mL, the strength of the discontinued FDA approved oral suspension
Commercial product	Commercial product discontinued
Strength and directions	Per prescriber
Dispensing	Valid prescription

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Phone (909) 378-7301. Fax (909) 378-7071

Clinical Advantages

Custom strength available
Alternative to swallowing pills
Dye free option
Discontinued product alternative

How It Works

What is Amphotericin B Oral Suspension?

Amphotericin B Oral Suspension is a compounded, swallowed liquid form of amphotericin B, prepared in SuspendIt for patients who need antifungal coverage through the GI tract rather than only in the mouth. It differs from Mixwell's amphotericin B oral rinse, which is used for swish contact with oral tissue rather than swallowed for GI action.

How it works

Amphotericin B is poorly absorbed from the gut, so a swallowed dose acts largely within the GI tract rather than reaching the bloodstream in significant amounts.
That local action is why prescribers order it for fungal coverage along the swallowing tube and gut, rather than for infections that have spread through the body.
A liquid lets the prescriber set a strength and volume by weight or by response, and lets patients who cannot take capsules use it.

When prescribers choose it

Gastroenterologists and infectious disease specialists managing esophageal candidiasis
Oncology and transplant teams using it for gut level antifungal coverage in high risk patients
Prescribers whose patients cannot swallow capsules
Prescribers continuing a regimen the discontinued commercial suspension used to cover

Clinical Details

What does the evidence show?

An oral amphotericin B suspension, 100 mg/mL, was FDA approved for oral and GI candidiasis and later discontinued; no manufacturer currently markets it [1]. Guidelines reserve systemic amphotericin B therapy, given intravenously, for serious invasive infections and do not recommend it for ordinary oral or esophageal candidiasis in patients with a normal immune system [2].

Findings come from the cited studies and do not promise any individual outcome.

Why is it compounded, and how is it typically used?

The approved oral suspension is no longer commercially made, so a prescriber who wants amphotericin B in a swallowed liquid form orders it compounded. Strength, volume, and duration are set by the prescriber. Mixwell compounds this suspension in Chino, California under USP 795 standards for non sterile preparations [3]. Our pharmacist confirms the strength with the prescriber before compounding, and the label carries storage and shake well instructions. Batch records document every preparation, and finished suspensions ship across California.

Safety information

Because a swallowed dose is poorly absorbed, the systemic warnings on amphotericin B's injectable labeling, kidney effects and infusion reactions, generally do not apply to this oral form the way they do to the IV product. Local side effects can include nausea, stomach upset, or an unpleasant taste. This suspension is not a substitute for IV amphotericin B in a serious, invasive infection. Patient selection, dosing, and duration are the prescriber's responsibility.

References

Fungizone (amphotericin B). Prescribing information history. Drugs.com
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 to e50. doi:10.1093/cid/civ933
United States Pharmacopeia. General Chapter 795, Pharmaceutical Compounding: Nonsterile Preparations. USP NF. Official November 1, 2023.

What to include on the prescription

APIs and strengths
Base or vehicle
Quantity
Directions for use
Refills
Allergies or dye free needs

Call (909) 378-7301 Fax (909) 378-7071

Compounded in Chino, CA. Delivered across California.

Chino
Chino Hills
Ontario
Pomona
Diamond Bar
Rancho Cucamonga
Eastvale

Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Compounded medications are not reviewed or approved by the FDA. Dispensed only with a valid prescription. Mixwell is a non sterile pharmacy and does not prepare sterile products or injectables. Compounded preparations are not presented as superior to commercially available products, and nothing here promises a specific result. Mixwell does not accept insurance. Call for pricing.

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