Anidulafungin

Aka: Anidulafungin, Eraxis

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II. Indications

  1. Conditions
    1. Candidemia (systemic Candidiasis)
    2. Esophageal Candidiasis
  2. Activity
    1. Candida species (including those resistant to Azole Antifungals)
    2. Aspergillus species (some activity)

III. Contraindications

  1. Resistant organisms
    1. Cryptococcus species
    2. Trichosporon species
    3. Dimorphic Fungi (e.g. Coccidioides, Blastomyces, Histoplasma)

IV. Mechanism

  1. Echinocandin (Cyclic Lipopeptide)
    1. Inhibits synthesis of beta-(1,3)-D-Glucan a key cell wall component
    2. Semi-synthetic derived from the fermentation product of the fungue Aspergillus nidulans

V. Dosing: Adult

  1. Candidemia (systemic Candidiasis)
    1. Load: 200 mg IV (infused at <1.1 mg/min) on day 1
    2. Next 100 mg IV (infused at <1.1 mg/min) daily for at least 14 days after the last positive culture
  2. Esophageal Candidiasis
    1. Load: 100 mg IV (infused at <1.1 mg/min) on day 1
    2. Next 50 mg IV (infused at <1.1 mg/min) daily for at least 14 days (and at least 7 days after symptoms have resolved)

VI. Dosing: Child (Off-label)

  1. Candidemia (systemic Candidiasis) for age 1 month and older
    1. Load: 3 mg/kg IV (infused at <1.1 mg/min) on day 1
    2. Next 1.5 mg/kg IV (infused at <1.1 mg/min) daily for at least 14 days after the last positive culture

VII. Adverse Effects

  1. Well tolerated overall
  2. Similar adverse effects to Caspofungin and Micafungin
  3. Anaphylaxis has occurred
  4. Histamine reactions (Pruritus, Urticaria)
    1. Occurs with more rapid infusion (avoid infusion rates >1.1 mg/min)

VIII. Safety

  1. Unknown safety in Lactation
  2. Pregnancy Category C
    1. Teratogenic in animals (and insufficient data in humans)

IX. Pharmacokinetics

  1. No renal dose adjustment needed
  2. Does not require dose adjustment in hepatic failure (unlike Caspofungin and Micafungin)

X. Drug Interactions

  1. No significant Drug Interactions

XI. Resources

  1. Anidulafungin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a88d9010-55fb-4a02-baff-042cd27688ea

XII. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2012) Med Lett Drugs Ther 10(120): 61-8 [PubMed]

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