Amphotericin B (AMB), either alone or incorporated into small unilamellar vesicles of pure dipalmitoylphosphatidyl choline (DPPC SUV-AMB), was administered intravenously to male Sprague-Dawley rats once daily for 5 days. Either 1.5 or 3.5 mg of AMB or DPPC SUV-AMB per kg was given, since these concentrations corresponded, respectively, to the lowest nephrotoxic dose and the sublethal dose of AMB in our model. Tubular functions were evaluated daily, and AMB concentrations in plasma, urine, and tissues were measured by high-performance liquid chromatography. AMB at both doses induced tubular toxicity, hyposthenuria being the earliest symptom. DPPC SUV-AMB at 1.5 mg/kg/day was atoxic, but the tubular alterations induced by 3.5 mg of DPPC SUV-AMB per kg were similar to those observed with 3.5 mg of AMB per kg, except that the ability to concentrate urine was partly restored 72 h after the last infusion. Incorporating AMB into DPPC SUV did not influence the pharmacokinetics of the drug. Using this lipidic AMB formulation, we thus observed a beneficial effect toward limiting the renal tubular toxicity of repeated low doses of AMB but, unexpectedly, not that of high doses. These results indicate that tubular renal functions and electrolyte serum values should be closely monitored in patients treated with AMB liposomal formulations, especially high-dose regimens.Systemic mycoses are a major cause of morbidity and mortality among immunocompromised patients (8,42,43). Although several new antifungal agents, particularly triazoles, have recently become available, amphotericin B (AMB) remains the most active drug for the treatment of opportunistic fungal infections (12,28). Its clinical use is limited by side effects, the most serious being nephrotoxicity. Harmful renal effects include inability to concentrate urine (1, 3, 4, 10), defective urinary acidification due to distal tubule dysfunction (10, 27, 31), renal potassium wasting (5), and depressed glomerular filtration rate (GFR) and renal plasma flow (6, 7).AMB toxicity was shown to be reduced when the drug was incorporated into liposomes or complexed with lipids (L-AMB), allowing higher doses to be infused and thereby increasing the efficiency of treatment in experimental fungal infections (23,36,37). However, the in vivo protective effect of liposomes (13, 38) or lipidic emulsions (18) against the experimental renal toxicity of AMB has been evaluated only after a single administration of the drug. Therefore, the experimental nephrotoxicity of L-AMB under conditions of repeated administration remains largely unknown. L-AMB has been used for the treatment of systemic mycoses in cancer patients with encouraging preliminary results (21, 22, 34), but again, the side effects on renal function have not been investigated in detail. Severe underlying disease, poor clinical conditions, previous treatment with free AMB, and multiple drug regimens might account for the difficulties encountered in evaluating renal function alterations in these * Corresponding author. patients. In ...