anidulafungin

Therapeutic Classification: antifungals

Pharmacologic Classification: echinocandins

REMS

Candidemia and other serious candidal infections, including intra-abdominal abscess, peritonitis.
Esophageal candidiasis.

Inhibits the synthesis of fungal cell wall.

Therapeutic effects:

Death of susceptible fungi.

Spectrum:

Active against Candida albicans, Candida glabrata, Candida parapsilosis, and Candida tropicalis.

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Undergoes chemical degradation without hepatic metabolism; <1% excreted in urine.

Half-Life: 40–50 hr.

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	24 hr

Contraindicated in:

Hypersensitivity;
Known or suspected hereditary fructose intolerance.

Use Cautiously in:

Underlying liver disease (may worsen);
OB: Safety not established in pregnancy; other antifungal agents preferred in pregnancy for infections caused by Candida;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children <1 mo (candidemia and intra-abdominal abscess and peritonitis caused by Candida or <18 yr (esophageal candidiasis); may lead to polysorbate toxicity in low-birth weight infants.

CV: hypotension

Derm: flushing, rash, urticaria

F and E: hypokalemia

GI: ↑liver enzymes, diarrhea

Resp: bronchospasm, dyspnea

Misc: ANAPHYLAXIS, infusion reactions

Drug-drug:

None reported.

Candidemia and Intra-abdominal Abscess or Peritonitis Caused by Candida

IV (Adults ): 200 mg loading dose on Day 1; then 100 mg once daily. Continue therapy for ≥14 days after last positive culture.
IV (Children ≥1 mo): 3 mg/kg (max = 200 mg) loading dose on Day 1; then 1.5 mg/kg (max = 100 mg) once daily. Continue therapy for ≥14 days after last positive culture.

Esophageal Candidiasis

IV (Adults ): 100 mg loading dose on Day 1; then 50 mg once daily. Continue therapy for a minimum of 14 days and for ≥7 days following resolution of symptoms.

Lyophilized powder for injection (contains fructose and polysorbate 80): 50 mg/vial; 100 mg/vial

Assess infected area at baseline and periodically during therapy to monitor effectiveness of therapy.
Monitor for anaphylaxis (rash, urticaria, flushing, pruritus, bronchospasm, dyspnea, hypotension); usually related to histamine release. If symptoms occur, stop therapy and provide appropriate treatment. ↓ risk by not exceeding recommended infusion rate.

Lab Test Considerations:

Obtain culture specimens before starting therapy. Therapy may be started before results are obtained.
May cause ↑ ALT, AST, alkaline phosphatase, and hepatic enzymes. If liver function abnormality occurs, monitor closely and consider discontinuing anidulafungin.
- May cause hypokalemia.
- May cause neutropenia and leukopenia.

IV Administration:

Adults: Intermittent Infusion: Reconstitution: Reconstitute each 50 mg vial with 15 mL or the 100 mg vial with 30 mL of sterile water for injection. Stable at room temperature for 24 hr. Concentration: 3.33 mg/mL.Diluent: For 50 mg dose, dilute contents of reconstituted vial with 50 mL of D5W or 0.9% NaCl for an infusion volume of 65 mL. For 100-mg dose, dilute contents of reconstituted vial with 100 mL of D5W or 0.9% NaCl for an infusion volume of 130 mL. For 200-mg dose,d ilute contents of two reconstituted 100-mg vials with 200 mL of D5W or 0.9% NaCl for an infusion volume of 260 mL. Concentration: 0.77 mg/mL. Do not administer solutions that are discolored or contain particulates. Stable for 48 hr at room temperature. Do not freeze.
Rate: Do not exceed 1.1 mg/min. Infuse 50 mg dose over ≥45 min, 100 mg dose over 90 min, or 200 mg dose over 180 min.
Children: Intermittent Infusion: Reconstitution: Reconstitute each 50 mg vial with 15 mL or the 100 mg vial with 30 mL of sterile water for injection. Stable at room temperature for 24 hr.Concentration: 3.33 mg/mL.Diluent: Dilute with 0.9% NaCl or D5W. Concentration: 0.77 mg/mL. Prepare in infusion syringe or IV infusion bag. Do not administer solutions that are discolored or contain particulates. Stable for 48 hr at room temperature. Do not freeze.
Rate: Do not exceed 1.1 mg/min.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- argatroban
- arsenic trioxide
- atracurium
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- busulfan
- butorphanol
- calcium chloride
- calcium gluconate
- cangrelor
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefepime
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftolozane/tazobactam
- ceftriaxone
- cefuroxime
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- clindamycin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- eptifibatide
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hydralazine
- hydrocortisone
- hydromorphone
- hydroxyzine
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin, regular
- irinotecan
- isavuconazonium
- isoproterenol
- ketorolac
- labetalol
- letermovir
- leucovorin calcium
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- mycophenolate
- nafcillin
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pantoprazole
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propranolol
- remifentanil
- rocuronium
- sodium acetate
- succinylcholine
- sufentanil
- sulbactam/durlobactam
- tacrolimus
- tedizolid
- theophylline
- thiotepa
- tirofiban
- tobramycin
- topotecan
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- dantrolene
- diazepam
- ertapenem
- gemtuzumab ozogamicin
- magnesium sulfate
- meropenem/vaborbactam
- nalbuphine
- pemetrexed
- phenytoin
- plazomicin
- potassium phosphates
- sodium bicarbonate
- sodium phosphates

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to notify health care professional immediately if signs and symptoms of anaphylaxis occur or if diarrhea becomes pronounced.
Inform patient that anidulafungin contains fructose. May be life-threatening when administered to patients with hereditary fructose intolerance.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Resolution of clinical and laboratory indication of fungal infection.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆