Anidulafungin

Summary

Anidulafungin is a semisynthetic echinocandin lipopeptide antifungal derived from Aspergillus nidulans fermentation product. It is approved for the treatment of candidemia, other forms of Candida infections (intra-abdominal abscess, peritonitis), and esophageal candidiasis. It is administered intravenously and does not undergo hepatic metabolism, being eliminated by slow chemical degradation.

Mechanism of Action

Non-competitive inhibition of beta-1,3-glucan synthase, an enzyme essential for fungal cell wall synthesis, leading to osmotic instability and fungal cell death. Targets the Fks subunit of glucan synthase.

Routes of Administration

Goals & Uses

• Treatment of invasive candidiasis (intra-abdominal, peritonitis)Antifungal TherapyHigh
• Empirical antifungal therapy in ICUAntifungal TherapyModerate
• Treatment of esophageal candidiasisAntifungal TherapyHigh
• Treatment of candidemiaAntifungal TherapyHigh
• Prophylaxis in high-risk patientsAntifungal ProphylaxisLow

Contraindications

• Hypersensitivity to polysorbate 80 (excipient)Excipient AllergyHigh
• Hypersensitivity to anidulafungin or other echinocandinsAllergyHigh

Adverse Effects

• Elevated liver enzymes (AST/ALT)HepatotoxicityCommon
• HypokalemiaElectrolyteCommon
• Hepatic failureHepatotoxicityRare
• Infusion-related reactions (flushing, hypotension, rash)Infusion ReactionUncommon
• Nausea/vomiting/diarrheaGastrointestinalCommon
• Deep vein thrombosis / phlebitisVascularUncommon

Drug Interactions

• CyclosporineLow
• VoriconazoleLow
• TacrolimusLow

Population Constraints

• Pediatric patientsAgeRelative
• Pregnancy (Category C/unknown risk)PregnancyRelative
• BreastfeedingReproductiveRelative
• Elevated liver enzymes at baselineHepatic ImpairmentRelative

Regulatory Status

• European UnionApprovedApproved: Invasive candidiasis in adult non-neutropenic patientsApproved by EMA under brand name Ecalta; esophageal candidiasis not in EU label
• United StatesApprovedApproved: Candidemia and other forms of Candida infections (intra-abdominal abscess, peritonitis), Esophageal candidiasisApproved by FDA in February 2006 under brand name Eraxis (Pfizer)
• United KingdomApprovedApproved: Invasive candidiasis in adult non-neutropenic patientsApproved by MHRA (retained from EU approval); marketed as Ecalta

Approved by the FDA in 2006 (Eraxis) and by the EMA (Ecalta). Not orally bioavailable; IV formulation only. No dose adjustment required for renal or hepatic impairment.

Evidence & Sources

No sources recorded yet.