Provider Briefing: The Amphotericin B Shortage in 2026

The Amphotericin B supply disruption continues to affect clinical decision-making across infectious disease, hematology-oncology, transplant medicine, and critical care settings. This article provides a concise, evidence-based summary of the current shortage, its implications for prescribing, and practical tools to help your patients access treatment.

For patient-facing information you can share with your patients, see our patient shortage update.

Shortage Timeline and Current Status

Amphotericin B has experienced intermittent supply disruptions since the mid-2010s. The current shortage phase is driven by the following developments:

Conventional Amphotericin B Deoxycholate

X-Gen Pharmaceuticals remains the sole U.S. supplier of the conventional lyophilized powder for injection (50 mg vials). Manufacturing delays have resulted in extended periods of unavailability with no estimated resupply date. ASHP's Drug Shortage Resource Center lists this as an active shortage.

Amphotericin B Lipid Complex (Abelcet)

Leadiant Biosciences has Abelcet 100 mg/20 mL vials on back order with no estimated release date. This further constrains lipid-based alternatives.

Liposomal Amphotericin B (AmBisome)

The liposomal formulation from Gilead Sciences has not been significantly affected by the shortage and remains the most reliably available formulation. However, the cost differential is substantial.

Prescribing Implications

The shortage has several practical implications for prescribers:

First-Line Therapy Adjustments

• Invasive aspergillosis: Voriconazole has been the IDSA-recommended first-line agent for over a decade and should be the default choice. Amphotericin B (lipid formulation) is recommended when Voriconazole is not feasible due to intolerance, contraindication, or resistance.
• Invasive candidiasis: Echinocandins (Caspofungin, Micafungin, Anidulafungin) are recommended as first-line therapy by IDSA. Lipid formulation Amphotericin B is a reasonable alternative for intolerance, limited availability, or resistance.
• Cryptococcal meningitis: The preferred induction regimen remains Amphotericin B (preferably liposomal) plus Flucytosine. If Amphotericin B is unavailable, high-dose Fluconazole with Flucytosine can be used as an alternative, though outcomes are inferior.
• Mucormycosis: This is the most critical area. Liposomal Amphotericin B remains the standard of care. Isavuconazonium (Cresemba) is the primary alternative, with Posaconazole for step-down therapy. The conventional deoxycholate form should not be used for mucormycosis due to the high doses required and associated nephrotoxicity.

Formulation Switching Considerations

When switching between formulations, note the dosing differences:

• Conventional deoxycholate: 0.5–1.5 mg/kg/day
• Liposomal (AmBisome): 3–6 mg/kg/day
• Lipid complex (Abelcet): 5 mg/kg/day

These are not interchangeable on a mg-per-mg basis. Ensure dosing is recalculated when switching formulations. Lipid formulations have a more favorable nephrotoxicity profile but at higher acquisition cost.

Renal-Sparing Strategies

If using conventional Amphotericin B deoxycholate (when available):

• Pre-hydration with 500–1,000 mL normal saline before each infusion
• Monitor renal function (BUN, creatinine) and electrolytes (potassium, magnesium) at least every other day
• Premedicate with acetaminophen, diphenhydramine, and/or hydrocortisone to manage infusion reactions
• Consider conversion to lipid formulation if creatinine doubles or rises above 2.5 mg/dL

Current Availability Picture

Based on ASHP Drug Shortage data and distribution reports:

• Conventional deoxycholate: Sporadic availability; some hospitals report intermittent stock from distributors
• Abelcet (ABLC): Effectively unavailable; no resupply timeline
• AmBisome (liposomal): Available through standard distribution channels
• Amphotec (cholesteryl sulfate complex): Limited availability; not widely stocked

Cost and Access Considerations

The cost differential between formulations creates access barriers:

• Conventional: ~$49–$70 per 50 mg vial
• AmBisome: ~$300–$1,200+ per 50 mg vial
• Full treatment course: $5,000–$50,000+ depending on formulation, weight-based dosing, and treatment duration

For hospitalized patients, Amphotericin B is typically billed under the medical benefit. Outpatient infusion may require prior authorization, particularly for lipid formulations. During documented shortages, most payers have expedited authorization pathways.

When patients face financial barriers, consider:

• Hospital financial assistance programs
• NeedyMeds and RxAssist for identifying assistance resources
• Social work referral for financial counseling

For more on cost management, see our provider's guide to helping patients save money on Amphotericin B.

Tools and Resources for Providers

• Medfinder for Providers: Search for real-time medication availability across pharmacies and hospital systems. Help patients locate facilities with current stock.
• ASHP Drug Shortage Resource Center: Monitor shortage status updates and therapeutic alternatives at ashp.org.
• FDA Drug Shortage Database: Check for FDA communications regarding supply at fda.gov.
• IDSA Practice Guidelines: Reference current treatment recommendations that account for drug availability.

For a practical workflow guide, see our article on how to help your patients find Amphotericin B in stock.

Looking Ahead

Several developments may improve the landscape:

• FDA incentives for shortage mitigation: The FDA has been working to encourage additional manufacturers to enter the market for critical shortage drugs.
• New antifungal agents: Several novel antifungals are in late-stage clinical development with broader spectra of activity.
• Expanded use of existing alternatives: Growing clinical experience with Isavuconazonium for mucormycosis and other difficult-to-treat infections is expanding the evidence base for alternatives.

However, in the near term, Amphotericin B — particularly the liposomal formulation — will remain an essential component of antifungal therapy for the most critical infections.

Final Thoughts

The Amphotericin B shortage requires active management from prescribers. Key actions include:

1. Defaulting to Voriconazole for aspergillosis and echinocandins for candidiasis where guidelines support it
2. Using liposomal Amphotericin B when Amphotericin B is essential (mucormycosis, cryptococcal meningitis induction)
3. Proactively communicating with pharmacy about availability and alternative agents
4. Leveraging tools like Medfinder to locate supply for patients
5. Documenting shortage-related treatment modifications for payer authorization

For patient-facing resources, direct patients to our guide on finding Amphotericin B in stock.