Anidulafungin

As a semisynthetic echinocandin, Anidulafungin is used in the fight against invasive fungal infection.

Overview:

Anidulafungin was approved by the FDA as an anti-fungal treatment in 2005. Since then, it has been a popular choice in alleviating the symptoms associated with peritonitis, intra-abdominal abcesses and esophageal candidiasis – most notably pain and difficulty in swallowing, as well as internal aches and discomfort.

In addition to treating certain fungal infections, Anidulafungin has been named as a potentially useful medication in the treatment of osteomyelitis, meningitis and endocarditis – although studies have not been carried out in sufficient numbers to determine its efficacy in treating these conditions. It is therefore only prescribed “off-label” at the discretion of a doctor for such treatments.

Anidulafungin differs from other anti-fungal medicines in that it degrades chemically to an inactive form at body temperature and pH. Because the drug does not rely on hepatic or renal excretion or enzymatic degradation, it is considered safe to use in patients with kidney or liver impairment. It functions by inhibiting glucan synthase, which is an enzyme associated with the formation of major fungal cell wall components.

In manufacturing, Anidulafungin is created via semi-synthesis. A starting material (echinocandin B) undergoes diacylation via the actions of an enzyme from the bacteria actinoplanes utahensis in order to synthesize the drug.

As an echinocandin, Anidulafungin targets the walls of fungal cells. By damaging these walls, the synthesis of further fungal cells is inhibited.

Conditions treated:

  • Esophageal candidiasis
  • Intra-abdominal abcess
  • Peritonitis
  • Endocarditis (off-label)
  • Meningitis (off-label)
  • Osteomyelitis (off-label)

Type of medicine:

  • Antifungal

Side effects:

Along with its required effects, Anidulafungin may also cause some unwanted side effects. The most common side effects associated with this medication include:

  • Tarry, black stools
  • Chills
  • A decrease in the level of urine
  • Dry mouth
  • Increased thirst
  • Fever
  • Irregular heartbeat
  • Appetite loss
  • Pain in the lower back or side
  • Changes in mood or mental wellbeing
  • Muscle cramps and pains
  • Vomiting or nausea
  • Tingling in the feet, hands or lips
  • Pale skin
  • Sores, white spots or ulcers in the mouth
  • Unusual bruising or bleeding
  • Unusual tiredness or weakness
  • Seizures
  • Shortness of breath

Most of these side effects should subside over time as the patient continues to receive the medication as prescribed. If side effects continue to persist or get worse over time, the patient should follow this up with their doctor immediately. For symptoms which only cause mild discomfort, a pharmacist or healthcare professional may be able to provide advice on how to alleviate these side effects. Dry mouth, for example, can be combatted by sucking on sugar-free rock candy, drinking a glass of cold water or chewing sugar-free gum.

Other side effects which occur infrequently, but enough to warrant mentioning, include:

  • Abdominal pain
  • Bleeding gums
  • Blood in stools or urine
  • Tightness in the chest
  • Constipation
  • Diarrhea
  • Dizziness
  • Excess heartbeats
  • Welts or hives
  • Incoherent or slurred speech
  • Irritability
  • Excess itching
  • A metallic taste in the mouth
  • Nervousness
  • Restlessness
  • Vomiting blood
  • Yellow eyes or skin

As with the most common side effects, the majority (if not all) of these should subside as treatment continues. However, one side effect which should be noted concerns the way Anidulafungin can potentially affect the psychology of the patient. Those undergoing treatment with this medicine may experience extreme mood swings, hallucinations, memory problems and confusion, as well a decrease in motor skills. It is therefore advised that patients refrain from operating heavy machinery or driving until it is established how the use of this medication will affect them, if at all.

If the patient experiences extreme discomfort as a result of using Anidulafungin, he or she is advised to seek emergency medical advice by visiting their local emergency ward or contacting services on 911.

Dosage:

Like all medications, Anidulafungin should only be administered as prescribed by a qualified healthcare professional. This means that patients are discouraged from taking larger doses of the drug than advised by a doctor. Taking the medicine in larger frequencies is also discouraged. Additionally, patients should refrain from taking the medication if advised to cease treatment on the direction of their doctor, even if they still have a supply of the medicine remaining.

Anidulafungin is available as a powder for intravenous administration in the following doses:

  • 50mg
  • 100mg

Dosage for esophageal candidiasis:

Initially, a patient receiving treatment with the drug will be given a starting dose of 100mg via an IV on the first day. Following this, a maintenance dose of 50mg should be administered once a day thereafter. Treatment should be given for at least a fortnight (14 days), and at least 7 days after symptoms have been resolved, in order to ensure any fungal infection has been sufficiently defeated, based on the patient’s clinical response. Patients who are infected with HIV should be offered suppressive anti-fungal therapy after a course of treatment with Anidulafungin in order to minimize any risk of relapse.

Dosage for Candidemia:

During the first day of treatment, an initial dose of 200mg should be administered via IV. A maintenance dose of 100mg should be administered once a day for at least 14 days after the last positive fungal culture has been detected. This is to ensure that small, untreated clusters of the fungus do not reproduce and cause the issue to be inflamed once again.

Overdose:

When administered in a clinical environment by a team of healthcare professionals, the potential to overdose on Anidulafungin should be small in comparison to self-administered medicines. If you suspect that you may have overdosed, it is important to notify your healthcare team as soon as possible.

Interactions:

Drugs have the potential to interact with other chemicals and drugs within the human body, and these interactions can affect the way medications function. It can lead to medications being ineffective at treating a condition, and in certain instances can even cause potentially harmful effects. Because of this, it is vital that all patients keep a detailed list of the medicines they are currently taking. This extends to over the counter remedies, herbal supplements and vitamins as well as any medicines prescribed by a doctor.

Below is a partial list of medications known to have interacted negatively with Anidulafungin. Patients who are currently undergoing treatment with any of the following drugs should consult their doctor, who may postpone treatment or adjust dosage in order to avoid harmful side effects:

  • Cyclosporine
  • Gengraf
  • Sandimmune
  • Neoral

Warnings:

The rate of Anidulafungin infusion should not exceed a dose of 1.1mg per minute. Use of Anidulafungin should be ceased immediately if the patient experiences bronchospasm, which involves tightness in the chest, wheezing and trouble breathing.

Patients should be closely monitored in the event of experiencing fevers, chills, body aches, sores or flu symptoms. In many instances, treatment should be discontinued.

Patients who experience jaundice, stomach pain and itching may also need to discontinue use of this medicine. Any patient who experiences these symptoms should report them to their healthcare professional immediately, who may decide to suggest an alterative treatment.

In some instances, anaphylactic reactions (including, but not limited to shock) have been reported in patients being treated with Anidulafungin. In the event of these reactions occurring, use of the medication should be discontinued and the appropriate anti-anaphylaxis treatment should be administered. Healthcare professionals should have complete access to such medications when administering Anidulafungin, and should take care to monitor the current condition of the patient during and after infusion.

Abnormalities in liver function tests have occasionally been observed in otherwise healthy volunteers and patients who have been tested or treated with Anidulafungin. Isolated cases of significant hepatitis, hepatic failure and dysfunction have been reported in rare instances, although a relationship has yet to have been established. Therapy with echinocandins such as Anidulafungin should be administered with caution in patients with pre-existing liver conditions, and liver function should be regularly monitored in a clinical setting during therapy.

Anidulafungin has been placed in Pregnancy Category B by the FDA. This is because animal studies have shown evidence of fetotoxicity. In some instances, Anidulafungin crossed the placental barrier, as well as being detected in fetal plasma. It is associated with incomplete ossification of bone matter. It is therefore advised that pregnant women only used Anidulafungin if the benefits outweigh the risks.

Anidulafungin was also found in the milk of lactating animals, and the manufacturer therefore recommends that caution be taken by healthcare professionals when considering the administration to anidulafungin to nursing women. If required, breastfeeding should be postponed until the course of treatment has been completed. Alternatively, nursing mothers may wish to continue breastfeeding whilst pursuing another course of anti-fungal treatment.

Storage:

Anidulafungin is available at a concentrated powder for infusion. It has a shelf life of three years.

This medicine should be stored in a refrigerator at a temperature of 2C to 8C. Storage requirements of the drug can differ dependent on whether it has been reconstituted or prepared as a solution.

As a powder, it can be stored at 25C for up to 96 hours, and it may be returned to refrigerated storage after this period.

As a reconstituted product, it may be stored at room temperature (25C) for up to 24 hours. From a microbiological agent perspective, it can be utilised for this entire period, after which point it will need to be destroyed.

As an infusion solution, it may be stored at 25C for up to 48 hours or frozen for up to 72 hours. Chemical and physical stability of the infusion soluion has been witnessed and demonstrated for up to 48 hours at room temperature.

Summary:

Anidulafungin, which is often marketed in the US, UK and wider Europe as Eraxis, is an effective treatment for a number of anti-fungal infections associated with candida. These include stomach and esophageal issues. Because this medicine requires no renal excretion, it is particularly useful for treating fungal infection in patients who have underlying kidney issues or diseases.

It should be used with caution in patients with hepatic problems, but overall it is a cost-effective clinical treatment for serious fungal infection. Intravenous administration of Anidulafungin should only take place in a clinical environment, under the directions of a qualified physician.

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Last Reviewed:
December 22, 2017
Last Updated:
February 09, 2018
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