the obvious [10%:<1% excreted in urine. 1 5 7 28 Half-life Distribution half-life is 0.5 1 hour; 1 terminal elimination half-life is 27 52 hours. 1 5 28 Special Populations Geriatric adults: Median clearance in adults 65 years of age slightly less than that in younger adults; dosage adjustments not required. 1 Hepatic impairment: Not metabolized in the liver; 1 6 7 9 concentrations not increased in adults with mild, moderate, or severe hepatic impairment (Child-Pugh class A, B, or C). 1 Renal impairment or end-stage renal disease: Negligible renal clearance; pharmacokinetics not affected by mild, moderate, or severe renal impairment. 1 Not removed by hemodialysis. 1 Stability Storage Parenteral Powder for IV Infusion 2 8 C; 1 may be exposed to temperatures up to 25 C for 96 hours and then returned to 2 8 C. 1 Do not freeze. 1 Following reconstitution with sterile water for injection, may be stored at temperatures up to 25 C for 24 hours. 1 Following further dilution in 5% dextrose injection or 0.9% sodium chloride injection to a concentration of 0.77 mg/mL, may be stored at temperatures up to 25 C for 48 hours or, alternatively, may be stored frozen for at least 72 hours. 1 Compatibility For information on systemic interactions resulting from concomitant use, see Interactions. Parenteral Solution Compatibility 1 Compatible Dextrose 5% Sodium chloride 0.9% Drug Compatibility HID Y-Site Compatibility Compatible Acyclovir sodium Amikacin sulfate Aminophylline Amphotericin B lipid complex Amphotericin B liposomal Ampicillin sodium Ampicillin sodium-sulbactam sodium Carboplatin Cefazolin sodium Cefepime HCl Cefoxitin sodium Ceftazidime Ceftriaxone sodium Cefuroxime sodium Ciprofloxacin Cisplatin Clindamycin phosphate Cyclophosphamide Cyclosporine Cytarabine Daunorubicin HCl Dexamethasone sodium phosphate Digoxin Dobutamine HCl Docetaxel Dopamine HCl Doripenem Doxorubicin HCl Epinephrine HCl Erythromycin lactobionate Etoposide phosphate Famotidine Fentanyl citrate Fluconazole Fluorouracil Furosemide Ganciclovir sodium Gemcitabine HCl Gentamicin sulfate Heparin sodium Hydrocortisone sodium succinate Ifosfamide Imipenem-cilastatin sodium Leucovorin calcium Levofloxacin Linezolid Meperidine HCl Meropenem Methylprednisolone sodium succinate Metronidazole Midazolam HCl Morphine sulfate Mycophenolate mofetil HCl Norepinephrine bitartrate Paclitaxel Pantoprazole sodium Phenylephrine HCl Piperacillin sodium-tazobactam sodium Potassium chloride Quinupristin-dalfopristin Ranitidine HCl Tacrolimus Ticarcillin disodium-clavulanate potassium Tobramycin sulfate Trimethoprim-sulfamethoxazole Vancomycin HCl Vincristine sulfate Voriconazole Zidovudine Incompatible Amphotericin B Ertapenem Sodium bicarbonate Actions and Spectrum Semisynthetic echinocandin antifungal; 1 lipopeptide synthesized from a fermentation product of Aspergillus nidulans . 1 Echinocandins (e.g., anidulafungin, caspofungin, micafungin) differ structurally and pharmacologically from other available antifungals. 1 2 4 5 6 7 11 Inhibits synthesis of β-d-glucan, an essential component of fungal cell walls that is not present in mammalian cells. 1 2 3 4 5 7 May be fungistatic or fungicidal in action. 1 2 3 4 5 7 13 Active in vitro against Candida , including C. albicans , 1 10 11 29 C. dubliniensis , 11 23 C. glabrata , 1 10 11 13 C. guilliermondii , 1 10 C. keyfri , 10 C. krusei , 1 10 11 C. lusitaniae , 10 C. metapsilosis , 37 C. orthopsilosis , 37 C. parapsilosis , 1 10 37 and C. tropicalis . 1 10 11 27 30 31 Clinical isolates of C. auris (often misidentified as C. haemulonii , C. famata , or Rhodotorula glutinis ) generally inhibited in vitro by anidulafungin concentrations of 0.125 1 mcg/mL. 505 508 508 Active against some strains of fluconazole-resistant C. albicans , 1 10 C. glabrata , 10 29 and C. krusei . 10 Active in vitro against Aspergillus , including A. fumigatus , A. flavus , A. niger , and A. terreus . 2 4 5 6 7 11 12 27 29 30 31 Like other echinocandins, not active against Cryptococcus neoformans , 2 4 5 11 27 29 30 31 Trichosporon , 2 29 31 33 Fusarium , 2 4 11 27 31 33 or zygomycetes. 2 4 29 30 31 33 Although clinical importance unclear, Candida (e.g., C. glabrata ) with reduced susceptibility to echinocandins reported. 1 425 Some clinical isolates of C. auris have reduced susceptibility or resistance to anidulafungin in vitro (i.e., MICs 4 mcg/mL). 504 508 509 510 Resistance to echinocandins usually due to point mutations within the genes (FKS1 and FKS2) encoding for subunits in the glucan synthase enzyme complex. 1 Potential for development of resistance or for cross-resistance with other echinocandins (caspofungin, micafungin) not known. 2 6 11 12 Active against some strains of C. glabrata resistant to caspofungin 13 and C. parapsilosis resistant to caspofungin and micafungin. 36 Advice to Patients Inform patients about risk of developing abnormal liver function tests and/or hepatic dysfunction and that liver function tests may be monitored during anidulafungin treatment. 1 Inform patients that anaphylactic reactions, including shock, reported in patients receiving anidulafungin. 1 Advise patients that the drug may be discontinued and appropriate treatment administered if such reactions occur. 1 Inform patients that infusion-related adverse reactions, possibly histamine mediated, may occur; 1 importance of reporting symptoms (e.g., rash, urticaria, flushing, pruritus, dyspnea, hypotension) to their clinician. 1 Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, and any concomitant illnesses. 1 Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. 1 Importance of informing patients of other important precautionary information. (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Anidulafungin Routes Dosage Forms Strengths Brand Names Manufacturer Parenteral For injection, for IV infusion 50 mg Eraxis Pfizer 100 mg Eraxis Pfizer AHFS DI Essentials. Copyright 2017, Selected Revisions September 4, 2017. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use is not currently included in the labeling approved by the US Food and Drug Administration. References 1. Pfizer Inc. Eraxis (anidulafungin) for injection for intravenous use prescribing information. New York, NY; 2015 Nov. 2. Denning DW. Echinocandin antifungal drugs. Lancet . 2003; 362:1142-51. [PubMed 14550704] 3. Krause DS, Simjee AE, van Rensburg C et al. A randomized, double-blind trial of anidulafungin versus fluconazole for the treatment of esophageal candidiasis. Clin Infect Dis . 2004; 39:770-5. [PubMed 15472806] 4. Zaas AK, Alexander BD. Echinocandins: role in antifungal therapy, 2005. Expert Opin Pharmacother . 2005; 6:1657-68. [PubMed 16086652] 5. Murdoch D, Plosker GL. Anidulafungin. Drugs . 2004; 64:2249-58. [PubMed 15456342] 6. Vazquez JA. Anidulafungin: a new echinocandin with a novel profile. Clin Ther . 2005; 27:657-73. [PubMed 16117974] 7. Raasch RH. Anidulafungin: review of a new echinocandin antifungal agent. Expert Rev Anti Infect Ther . 2004; 2:499-508. [PubMed 15482216] 8. Krause DS, Reinhardt J, Vazquez JA et al. Phase 2, randomized, dose-ranging study evaluating the safety and efficacy of anidulafungin in invasive candidiasis and candidemia. Antimicrob Agents Chemother . 2004; 48:2021-4. [PubMed 15155194] 9. Dowell JA, Stogniew M, Krause D et al. Assessment of the safety and pharmacokinetics of anidulafungin when administered with cyclosporine. J Clin Pharmacol . 2005; 45:227-33. [PubMed 15647416] 10. Pfaller MA, Boyken L, Hollis RJ et al. In vitro activities of anidulafungin against more than 2,500 clinical isolates of Candida spp., including 315 isolates resistant to fluconazole. J Clin Microbiol . 2005; 43:5425-7. [PubMed 16272464] 11. Cappelletty D, Eiselstein-McKitrick K. The echinocandins. Pharmacotherapy . 2007; 27:369-88. [PubMed 17316149] 12. Vazquez JA, Sobel JD. Anidulafungin: a novel echinocandin. Clin Infect Dis . 2006; 43:215-22. [PubMed 16779750] 13. Cota J, Carden M, Graybill JR et al. In vitro pharmacodynamics of anidulafungin and caspofungin against Candida glabrata isolates, including strains with decreased caspofungin susceptibility. Antimicrob Agents Chemother . 2006; 50:3926-8. [PubMed 16940061] 14. Dowell JA, Stogniew M, Krause D et al. Lack of pharmacokinetic interaction between anidulafungin and tacrolimus. J Clin Pharmacol . 2007; 47:305-14. [PubMed 17322142] 15. Dowell JA, Stogniew M, Krause D et al. Anidulafungin does not require dosage adjustment in subjects with varying degrees of hepatic or renal impairment. J Clin Pharmacol . 2007; 47:461-70. [PubMed 17389555] 16. Philip A, Odabasi Z, Rodriguez J et al. In vitro synergy testing of anidulafungin with itraconazole, voriconazole, and amphotericin B against Aspergillus spp. and Fusarium spp. Antimicrob Agents Chemother . 2005; 49:3572-4. [PubMed 16048988] 17. Dowell JA, Schranz J, Baruch A et al. Safety and pharmacokinetics of coadministered voriconazole and anidulafungin. J Clin Pharmacol . 2005; 45:1373-82. [PubMed 16291712] 18. Benjamin DK, Driscoll T, Seibel NL et al. Safety and pharmacokinetics of intravenous anidulafungin in children with neutropenia at high risk for invasive fungal infections. Antimicrob Agents Chemother . 2006; 50:632-8. [PubMed 16436720] 19. Reboli AC, Rotstein C, Pappas PG et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med . 2007; 356:2472-82. [PubMed 17568028] 22. Karlowsky JA, Hoban DJ, Zhanel GG et al. In vitro interactions of anidulafungin with azole antifungals, amphotericin B and 5-fluorocytosine against Candida species. Int J Antimicrob Agents . 2006; 27:174-7. [PubMed 16414247] 23. Jacobsen MD, Whyte JA, Odds FC. Candida albicans and Candida dubliniensis respond differently to echinocandin antifungal agents in vitro. Antimicrob Agents Chemother . 2007; 51:1882-4. [PubMed 17307974] 27. Estes KE, Penzak SR, Calis KA et al. Pharmacology and antifungal properties of anidulafungin, a new echinocandin. Pharmacotherapy . 2009; 29:17-30. [PubMed 19113794] 28. Damle BD, Dowell JA, Walsky RL et al. In vitro and in vivo studies to characterize the clearance mechanism and potential cytochrome P450 interactions of anidulafungin. Antimicrob Agents Chemother . 2009; 53:1149-56. [PubMed 19029327] 29. Morris MI, Villmann M. Echinocandins in the management of invasive fungal infections, part 1. Am J Health Syst Pharm . 2006; 63:1693-703. [PubMed 16960253] 30. Kauffman CA, Carver PL. Update on echinocandin antifungals. Semin Respir Crit Care Med . 2008; 29:211-9. [PubMed 18366002] 31. Kim R, Khachikian D, Reboli AC. A comparative evaluation of properties and clinical efficacy of the echinocandins. Expert Opin Pharmacother . 2007; 8:1479-92. [PubMed 17661730] 32. Juang P. Update on new antifungal therapy. AACN Adv Crit Care . 2007 Jul-Sep; 18:253-60; quiz 261-2. 33. de la Torre P, Meyer DK, Reboli AC. Anidulafungin: a novel echinocandin for candida infections. Future Microbiol . 2008; 3:593-601. [PubMed 19072176] 34. Vazquez JA, Schranz JA, Clark K et al. A phase 2, open-label study of the safety and efficacy of intravenous anidulafungin as a treatment for azole-refractory mucosal candidiasis. J Acquir Immune Defic Syndr . 2008; 48:304-9. [PubMed 18545153] 35. Eschenauer G, Depestel DD, Carver PL. Comparison of echinocandin antifungals. Ther Clin Risk Manag . 2007; 3:71-97. [PubMed 18360617] 36. Moudgal V, Little T, Boikov D et al. Multiechinocandin- and multiazole-resistant Candida parapsilosis isolates serially obtained during therapy for prosthetic valve endocarditis. Antimicrob Agents Chemother . 2005; 49:767-9. [PubMed 15673762] 37. Lockhart SR, Messer SA, Pfaller MA et al. Geographic distribution and antifungal susceptibility of the newly described species Candida orthopsilosis and Candida metapsilosis in comparison to the closely related species Candida parapsilosis. J Clin Microbiol . 2008; 46:2659-64. [PubMed 18562582] 292. American Academy of Pediatrics. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.EA 423. Patterson TF, Thompson GR, Denning DW et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis . 2016; 63:e1-e60. Updates may be available at IDSA website at www.idsociety.org. [PubMed 27365388] 425. Pappas PG, Kauffman CA, Andes DR et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis . 2016; 62:e1-50. Updates may be available at IDSA website at www.idsociety.org. [PubMed 26679628] 436. . Antifungal drugs. Treat Guidel Med Lett . 2012; 10:61-8; quiz 69-70. [PubMed 22825657] 440. Panel on Opportunistic Infection in HIV-infected Adults and Adolescents, US Department of Health and Human Services (HHS). Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (September 17, 2015). Updates may be available at HHS AIDS Information (AIDSinfo) website. 441. Panel on Opportunistic Infection in HIV-exposed and HIV-infected children, US Department of Health and Human Services (HHS). Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics (Nov 6, 2013). Updates may be available at HHS AIDS Information (AIDSinfo) website. 504. Tsay S, Welsh RM, Adams EH et al. Notes from the Field: Ongoing Transmission of Candida auris in Health Care Facilities - United States, June 2016-May 2017. MMWR Morb Mortal Wkly Rep . 2017; 66:514-515. [PubMed 28520710] 505. Larkin E, Hager C, Chandra J et al. The Emerging Pathogen Candida auris: Growth Phenotype, Virulence Factors, Activity of Antifungals, and Effect of SCY-078, a Novel Glucan Synthesis Inhibitor, on Growth Morphology and Biofilm Formation. Antimicrob Agents Chemother . 2017; 61 [PubMed 28223375] 506. Lee WG, Shin JH, Uh Y et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol . 2011; 49:3139-42. [PubMed 21715586] 507. Vallabhaneni S, Kallen A, Tsay S et al. Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus-United States, May 2013-August 2016. Am J Transplant . 2017; 17:296-299. [PubMed 28029734] 508. Kathuria S, Singh PK, Sharma C et al. Multidrug-Resistant Candida auris Misidentified as Candida haemulonii: Characterization by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry and DNA Sequencing and Its Antifungal Susceptibility Profile Variability by Vitek 2, CLSI Broth Microdilution, and Etest Method. J Clin Microbiol . 2015; 53:1823-30. [PubMed 25809970] 509. Lockhart SR, Etienne KA, Vallabhaneni S et al. Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses. Clin Infect Dis . 2017; 64:134-140. [PubMed 27988485] 510. Centers for Disease Control and Prevention. Candida auris interim recommendations for healthcare facilities and laboratories. From CDC website. Accessed 2017 May 30. HID. ASHP s interactive handbook on injectable drugs. McEvoy, GK, ed. Bethesda, MD: American Society of Health-System Pharmacists, Inc; Updated December 18, 2014. From HID website. Next Interactions Print this page Add to My Med List More about anidulafungin Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: echinocandins Consumer resources Anidulafungin Anidulafungin Intravenous (Advanced Reading) Professional resources Anidulafungin (Wolters Kluwer) Other brands: Eraxis Related treatment guides Candidemia Esophageal Candidiasis> ]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only B Pregnancy Category No proven risk in humans N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Drug Class Echinocandins Related Drugs Candidemia fluconazole , Diflucan , itraconazole , voriconazole , amphotericin b , Sporanox , posaconazole , caspofungin , micafungin , Mycamine , AmBisome , Noxafil , More... Esophageal Candidiasis fluconazole , Diflucan , itraconazole , voriconazole , amphotericin b , Sporanox , caspofungin , micafungin , Mycamine , Vfend , Cancidas , Onmel , More... Anidulafungin Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first!} } locate
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