Anidulafungin

• Approved Indications:
• Treatment of invasive candidiasis, including candidemia, in adults.
• Treatment of esophageal candidiasis.
• Empiric antifungal therapy in febrile neutropenic patients suspected of fungal infections.
• Off-label/Clinically Accepted Uses:
• Treatment of other invasive fungal infections caused by Candida species resistant to other antifungals.
• Combination therapy for refractory fungal infections.

• Route: Intravenous (IV) infusion only.
• Adults:
• Loading dose: 200 mg IV on day 1.
• Maintenance dose: 100 mg IV once daily thereafter.
• Duration: Usually 14 days after last positive culture or resolution of signs and symptoms.
• Elderly: Same as adults; no dosage adjustment required.
• Pediatrics: Safety and efficacy not established.
• Renal Impairment: No dosage adjustment required.
• Hepatic Impairment: No dosage adjustment required.
• Administration: Administer IV over 60 minutes; reconstitute and dilute as per instructions.

Anidulafungin is an echinocandin antifungal that inhibits the enzyme 1,3-β-D-glucan synthase, essential for synthesis of β-glucan, a critical component of the fungal cell wall. Inhibition disrupts cell wall integrity, leading to osmotic instability and fungal cell death, exhibiting fungicidal activity against Candida species.

• Absorption: Not applicable (IV administration).
• Distribution: Extensive tissue distribution; protein binding approximately 99%.
• Metabolism: Undergoes slow chemical degradation to inactive metabolites; minimal hepatic metabolism.
• Half-life: Approximately 24-48 hours, allowing once-daily dosing.
• Elimination: Primarily eliminated via slow non-enzymatic degradation; minimal renal or hepatic excretion.

• Pregnancy: Category B — animal studies show no fetal risk, but adequate human studies lacking. Use only if clearly needed.
• Lactation: Unknown if excreted in human milk; caution advised; breastfeeding not recommended during treatment.

• Antifungal agent, Echinocandin class.

• Known hypersensitivity to anidulafungin or any component of the formulation.
• Use cautiously in patients with severe hypersensitivity history.

• Monitor for hypersensitivity reactions including anaphylaxis; discontinue if occurs.
• Infusion-related reactions possible; monitor vital signs during administration.
• Hepatic function monitoring recommended during therapy.
• Use with caution in patients with liver disease.
• Risk of superinfection with prolonged use.

• Common: Fever, nausea, vomiting, headache, diarrhea, hypokalemia, elevated liver enzymes.
• Serious (rare): Anaphylaxis, serious hypersensitivity reactions, hepatic failure, infusion site reactions.
• Onset: Side effects typically occur within days of treatment initiation.

• Minimal cytochrome P450 involvement; low potential for drug interactions.
• No significant interactions with common immunosuppressants, antifungals, or antibiotics.
• Monitor when co-administered with drugs known to cause hepatotoxicity.

• Recommended as a first-line agent for invasive candidiasis in recent infectious disease guidelines.
• Increasing role in treating resistant Candida infections due to favorable safety profile.
• Emphasis on early initiation for better outcomes in neutropenic patients.

• Store powder and reconstituted solution at 20°C to 25°C (68°F to 77°F).
• Protect from light and moisture.
• Use reconstituted solution within recommended time.
• Do not freeze.