Which antifungal drug is associated with the 'lipid formulation' strategy (liposomal amphotericin B, ABLC) to reduce nephrotoxicity, and what is the mechanism of this toxicity reduction?

• A Voriconazole; liposomal formulation prevents accumulation of its hepatotoxic metabolite voriconazole N-oxide in renal tissue
• B Fluconazole; liposomes increase tubular secretion reducing drug accumulation in the kidney
• C Caspofungin; lipid complex prevents complement-mediated renal tubular inflammation
• D Amphotericin B; liposomal encapsulation reduces free drug binding to cholesterol in renal tubular cells while maintaining delivery to fungal ergosterol-rich membranes ✓

Explanation

Amphotericin B (AmB) binds to both fungal ergosterol and mammalian cholesterol in renal tubular cells, causing pore formation, ion leakage, and direct nephrotoxicity. Liposomal and lipid-complex formulations encapsulate AmB in lipid bilayers; the drug preferentially transfers to ergosterol-rich fungal membranes rather than cholesterol-rich mammalian renal membranes, reducing nephrotoxicity while maintaining antifungal efficacy. This also reduces infusion-related reactions.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.