Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
AMPHOTEC vs EXSEL
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Amphotericin B binds to ergosterol in fungal cell membranes, forming pores that disrupt membrane integrity, leading to leakage of intracellular contents and cell death.
Exsel (selenium sulfide) is an antifungal agent that reduces the production of cutaneous oils and exerts cytostatic effects on epidermal cells. It inhibits the growth of Pityrosporum ovale and other fungi by interfering with oxidative enzyme systems, leading to decreased sebum production and normalization of epidermal turnover.
Treatment of progressive, potentially life-threatening fungal infections: aspergillosis, cryptococcosis, blastomycosis, systemic candidiasis, coccidioidomycosis, histoplasmosis, mucormycosis, sporotrichosis,Treatment of visceral leishmaniasis (off-label),Empiric therapy in febrile neutropenic patients (off-label),Treatment of primary amebic meningoencephalitis (off-label)
Treatment of tinea versicolor (pityriasis versicolor),Management of dandruff and seborrheic dermatitis of the scalp
Initial dose: 0.5 mg/kg intravenously once daily, titrated as tolerated to 5 mg/kg once daily.
1-2 mg orally once daily; maximum dose 2 mg/day.
Terminal half-life: 24-48 hours (up to 7 days in hepatic impairment). Long half-life allows once-daily dosing.
Terminal half-life: 12-18 hours (mean 15 h); requires dose adjustment in renal impairment (Cr Cl <30 m L/min).
Metabolized minimally, if at all; elimination is primarily via unchanged drug excretion in urine and bile over a prolonged period.
Minimal systemic absorption after topical application; any absorbed selenium is primarily excreted in urine, with minor metabolism via reduction to selenides and methylation to dimethylselenide.
Biliary/fecal: ~90% unchanged; renal: <10% (mainly as metabolite).
Renal: ~70% unchanged; biliary/fecal: ~30% as metabolites.
>95% bound to albumin and alpha-1-acid glycoprotein.
95% bound to albumin and alpha-1-acid glycoprotein.
4.0 L/kg (large, indicates extensive tissue binding, especially in liver, spleen, and lungs).
0.8-1.2 L/kg; indicates extensive extravascular distribution.
Not applicable (IV only); if oral, <5% (due to poor absorption and first-pass metabolism).
Oral: 60-80%; first-pass metabolism reduces bioavailability by 20-40%.
No dose adjustment required for renal impairment; however, monitor renal function closely during therapy.
No adjustment required for mild to moderate impairment. Severe impairment (GFR <30 m L/min): contraindicated.
No specific dose adjustment recommended; use with caution in severe hepatic impairment.
Child-Pugh A: no adjustment. Child-Pugh B or C: contraindicated.
5 mg/kg intravenously once daily; safety and efficacy not established in neonates.
Not recommended for use in pediatric patients due to lack of safety and efficacy data.
No specific dose adjustment; monitor renal function and electrolyte levels due to age-related decline in renal function.
Start at 1 mg orally once daily; titrate cautiously due to increased risk of falls and hypotension.
This drug should be used primarily for treatment of patients with progressive, potentially life-threatening fungal infections; it is not intended for treatment of non-invasive fungal infections (e.g., oral thrush, vaginal candidiasis) in patients with normal neutrophil counts.
None.
Nephrotoxicity: monitor renal function closely; risk increased with concurrent nephrotoxic drugs.,Infusion-related reactions: fever, chills, rigors, hypotension, dyspnea; premedicate as needed.,Electrolyte abnormalities: hypokalemia, hypomagnesemia; monitor levels and replace.,Hepatotoxicity: monitor liver function tests.,Cardiotoxicity: arrhythmias, especially with rapid infusion or hypokalemia.,Pulmonary toxicity: acute pulmonary edema (rare), especially in patients with low ejection fraction.
Avoid contact with eyes, eyelids, and mucous membranes. If contact occurs, rinse thoroughly with water. Discontinue if local irritation or sensitization develops. Use with caution in patients with inflamed or broken skin due to increased absorption risk. Not for use on large areas of the body for prolonged periods.
Hypersensitivity to amphotericin B or any component of the formulation (unless condition is life-threatening and amenable only to amphotericin therapy).
Hypersensitivity to selenium sulfide or any component of the formulation. Do not use on broken or inflamed skin.
No specific food interactions. Ensure adequate hydration and electrolyte intake as directed. Avoid grapefruit juice as it may alter drug metabolism.
No known food interactions.
Amphotericin B (AMPHOTEC) is classified as category B. Animal studies have not demonstrated fetal harm, but there are no adequate human studies in pregnant women. Inadvertent use during the first trimester is not associated with a significant increase in congenital anomalies. During the second and third trimesters, there is no evidence of fetal toxicity, although the drug should be used only if clearly needed due to maternal systemic fungal infection.
Pregnancy Category D. First trimester: Associated with Ebstein's anomaly and other congenital heart defects; avoid if possible. Second and third trimesters: Risk of fetal hyperthyroidism or hypothyroidism, cranial synostosis, intellectual disability, and neonatal goiter if maternal hyperthyroidism is treated with this drug. Use only if clearly needed and maternal benefit outweighs fetal risk.
Amphotericin B is excreted into breast milk in low concentrations. The M/P ratio is unknown. It is considered compatible with breastfeeding because of poor oral bioavailability; however, caution is advised, and monitoring for infant diarrhea or thrush is recommended.
Excreted in human milk. M/P ratio not available. Potential for serious adverse reactions in nursing infants, including thyroid dysfunction and arrhythmias. Decision to discontinue nursing or drug based on importance of drug to mother.
Pharmacokinetic changes in pregnancy (increased volume of distribution, altered clearance) may require dose adjustment. Standard dosing is 3-5 mg/kg/day IV, but serum concentrations should be monitored to ensure therapeutic levels without excessive toxicity. Dose may need to be increased by 25-50% in the third trimester.
Pregnancy may increase clearance of this drug; dose adjustments often not required, but individualize based on maternal thyroid function and clinical response. Lower doses may be needed to avoid fetal hypothyroidism.
Amphotec (amphotericin B liposomal) is the preferred formulation for invasive fungal infections due to reduced nephrotoxicity compared to deoxycholate. Monitor for infusion-related reactions (fever, rigors, hypotension) and premedicate with acetaminophen, diphenhydramine, and hydrocortisone. Requires baseline and serial renal function, electrolytes (especially potassium, magnesium), and liver function tests. Do not use with other nephrotoxic drugs if possible. Electrolyte repletion is critical.
EXSEL (selenium disulfide) 2.5% shampoo: Use twice weekly for 2 weeks, then once weekly for maintenance. Limit application to 5-10 minutes before rinsing. Avoid contact with eyes or broken skin. Can cause temporary hair discoloration (especially on bleached or permed hair). May stain jewelry and clothing. For dandruff and seborrheic dermatitis of the scalp.
This medication treats serious fungal infections and is given intravenously in a hospital setting.,You may experience fever, chills, or shaking during the infusion; these can be managed with premedications.,Kidney function and blood electrolyte levels will be monitored regularly.,Report any signs of allergic reaction (rash, itching, difficulty breathing) or symptoms of electrolyte imbalance (muscle cramps, weakness, irregular heartbeat).,Avoid taking other medications that can harm the kidneys (e.g., certain antibiotics, NSAIDs) without consulting your doctor.
Shake bottle well before use.,Wet hair thoroughly before applying shampoo.,Apply enough shampoo to lather and massage into scalp for 2-3 minutes.,Leave on scalp for 5 minutes (up to 10 minutes) before rinsing thoroughly.,Rinse hair and scalp completely to avoid residue.,Use twice weekly for first 2 weeks, then once weekly as directed.,Avoid contact with eyes; if contact occurs, rinse thoroughly with water.,Do not use on broken or irritated skin.,Discontinue use and consult doctor if rash or irritation develops.,May stain clothing and jewelry; rinse thoroughly after use.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about AMPHOTEC vs EXSEL, answered by our medical review team.
AMPHOTEC is a Antifungal that works by Amphotericin B binds to ergosterol in fungal cell membranes, forming pores that disrupt membrane integrity, leading to leakage of intracellular contents and cell death.. EXSEL is a Topical Antifungal that works by Exsel (selenium sulfide) is an antifungal agent that reduces the production of cutaneous oils and exerts cytostatic effects on epidermal cells. It inhibits the growth of Pityrosporum ovale and other fungi by interfering with oxidative enzyme systems, leading to decreased sebum production and normalization of epidermal turnover.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between AMPHOTEC and EXSEL depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of AMPHOTEC is: Initial dose: 0.5 mg/kg intravenously once daily, titrated as tolerated to 5 mg/kg once daily.. The standard adult dose of EXSEL is: 1-2 mg orally once daily; maximum dose 2 mg/day.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between AMPHOTEC and EXSEL in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. AMPHOTEC is classified as Category C. Amphotericin B (AMPHOTEC) is classified as category B. Animal studies have not demonstrated fetal harm, but there are no adequate human studies in pregnant women. Inadvertent use d. EXSEL is classified as Category C. Pregnancy Category D. First trimester: Associated with Ebstein's anomaly and other congenital heart defects; avoid if possible. Second and third trimesters: Risk of fetal hyperthyr. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.