anidulafungin

anidulafungin,

a systemic, antifungal agent.

indications This drug is used to treat Candida albicans, C. glabrata, C. parapsilosis, and C. tropicalis.

contraindications Known hypersensitivity to this drug or other echinocandins prohibits its use.

adverse effects Adverse effects of this drug include dizziness, deep vein thrombosis, hypotension, hypokalemia, hypocalcemia, hyperglycemia, hyperkalemia, hypernatremia, and (rarely) hypomagnesemia. Life-threatening side effects include seizures, atrial fibrillation, right bundle branch block, sinus arrhythmia, thrombophlebitis, (rarely) superficial ventricular extra systoles, hepatic necrosis, neutropenia, thrombocytopenia, leukopenia, and coagulopathy. Common side effects include headache, nausea, anorexia, vomiting, diarrhea, rash, back pain, rigors, and increased aspartate aminotransferase and alanine aminotransferase.

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anidulafungin

Eraxis

Pharmacologic class: Semisynthetic echinocandin

Therapeutic class: Antifungal

Pregnancy risk category C

Action

Inhibits glucan synthase, an enzyme present in fungal (but not mammalian) cells; this action inhibits formation of 1,3-beta-D-glucan, an essential component of fungal cell wall.

Availability

Powder for injection (lyophilized): 50-mg single-use vial

⊘Indications and dosages

➣ Candidemia and other Candida infections (intra-abdominal abscess, peritonitis)

Adults: Single 200-mg loading dose by I.V. infusion on day 1, followed by 100 mg I.V. daily thereafter. Duration depends on clinical response; generally, therapy continues at least 14 days after last positive culture.

➣ Esophageal candidiasis

Adults: Single 100-mg loading dose by I.V. infusion on day 1, followed by 50 mg I.V. daily thereafter. Treatment should continue for at least 14 days, and for at least 7 days after symptoms resolve; duration depends on clinical response. Due to risk of esophageal candidiasis relapse in patients with human immunodeficiency virus, suppressive antifungal therapy may be considered after treatment ends.

Contraindications

• Hypersensitivity to drug, its components, or other echinocandins

Precautions

Use cautiously in:
• hepatic impairment
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

☞ Don't give by I.V. bolus.
• Reconstitute only with supplied diluent (20% dehydrated alcohol in water for injection).
• Further dilute only with 5% dextrose injection or normal saline solution, to yield infusion solution concentration of 0.5 mg/ml.
• Give by I.V. infusion within 24 hours of reconstitution.
☞ Don't infuse at a rate exceeding 1.1 mg/minute.
• Don't dilute with other solutions or infuse through same I.V. line with other drugs or electrolytes.

Route	Onset	Peak	Duration
I.V.	Unknown	Unknown	Unknown

Adverse reactions

CNS: headache

CV: hypotension, phlebitis

GI: aggravated dyspepsia, nausea, vomiting

Hematologic: neutropenia, leukopenia

Respiratory: dyspnea

Skin: rash, urticaria, pruritus, flushing

Other: fever

Interactions

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotranferase, gamma glutamyltransferase: increased

Patient monitoring

• If patient has abnormal liver function tests during therapy, monitor for evidence of worsening hepatic function and weigh risks and benefits of continuing therapy.
• Monitor for rash, urticaria, flushing, dyspnea, and hypotension. (However, these are rare when drug is administered slowly).

Patient teaching

☞ Instruct patient to report rash, itching, unusual bruising or bleeding, unusual tiredness, or yellowing of skin or eyes.
• Advise patient to report troublesome side effects such as GI upset.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the tests mentioned above.