Which antifungal carries a high risk of infusion-related reactions?

Amphotericin B is known to carry a high risk of infusion-related reactions due to its mechanism of action and pharmacological properties. This antifungal agent is a polyene that binds to ergosterol in fungal cell membranes, leading to altered membrane permeability and ultimately cell death. However, this binding can also affect human cells that contain cholesterol, especially at higher doses or with rapid infusion rates, resulting in significant side effects.

Infusion-related reactions with Amphotericin B can include fever, chills, rigors, and hypotension. These responses are often due to the release of cytokines and other inflammatory mediators triggered by the drug. To mitigate these infusion-related reactions, premedication with antipyretics, antihistamines, or corticosteroids is commonly employed before administration of the drug.

In comparison, other antifungals listed have different safety profiles and are less likely to cause such dramatic infusion-related reactions. Voriconazole can have its own set of side effects but is not highlighted for infusion reactions. Fluconazole is generally well-tolerated with minimal infusion-related issues. Caspofungin, while it has some side effects, is primarily associated with other types of toxicities rather than infusion-related reactions.