anidulafungin

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.

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 aminotransferase, 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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

anidulafungin

An echinocandin antifungal drug with potent effect against candida species used in the treatment of invasive candidiasis. The drug is thought to be as effective as fluconazole.

Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005