Anidulafungin

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Definition
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Echinocandin antifungal. A semi-synthetic echinocandin (lipopeptide) from a fermentation product of Aspergillus nidulans. No cross-resistance in vitro with other classes of antimycotics.

Pharmacodynamics (Effect)
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Selective, non-competitive inhibition of the enzyme 1,3-ß-D-glucan synthase which is present in the fungal cell. This results in the inhibition of the synthesis of 1,3-ß-D-glucan, an essential component of the fungal cell wall. This causes the death of the fungal cell.

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Spectrum of action
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In vivo fungicidal activity against Candida spp. including fluconazole resistant species, especially C. albicans, C. tropicalis, C. glabrata, C. krusei.
In vivo limited activity against C. parapsilosis, C. guilliermondii and C. lusitaniae.
In vitro good activity against Aspergillus spp., especially against A. fumigatus, A. flavus, A. terreus. Good activity against trophic and cystic forms of Pneumocystis jiroveci.
In vitro limited effectiveness against Bipolaris spp., Cladiophialophora bantiana, Pseudallescheria boydii, Scedosprium prolificans, Histoplasma capsulatum.
Not effective against T. beigelii, Blastomyces dermatitidis, Sporothrix schenckii, Rhizopus spp.

Indication
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Invasive candidosis in adult, non-neuropenic patients.

Pregnancy/nursing period
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Not recommended for use during pregnancy or lactation. Insufficient data available.

Dosage and method of use
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Initially 200 mg i.v. as single dose (infuse slowly over 3 hours). Then 100 mg i.v. once/day (infuse slowly for 90 minutes). Therapy duration according to the clinic. In general, antimycotic therapy should be continued for at least 14 days after the last positive culture result.

Undesirable effects
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Occasionally disorders of blood clotting, headaches, nausea, diarrhea, flatulence, drug exanthema, itching, hypokalemia, hot flashes, passager increased liver values, thrombocytopenia.

Contraindication
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patients with hereditary fructose intolerance.

Preparations
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Ecalta

Note(s)
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Remember! Anidulafungin is very poorly soluble in water. The finished infusion solution contains 24 Vol% ethanol. This corresponds to 6 g ethanol in the maintenance dose of 100 mg or 12 g ethanol in the initial dose of 200 mg.
Caution! The alcohol content can influence the effectiveness of other drugs and impair the ability to drive or operate machines.