anidulafungin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
anidulafungin: clinical details
Prescribing considerations
- Initiation should be by a clinician experienced in invasive fungal infection management.
- Obtain specimens for fungal culture before treatment where feasible; treatment may begin before results and be reviewed when identification and susceptibility information become available.
- Evidence is limited in neutropenic patients and absent for Candida endocarditis, osteomyelitis and meningitis.
- Use in neonates under 1 month is not recommended; central nervous system penetration and polysorbate exposure are important concerns.
- Review hereditary fructose intolerance history before administration.
Contraindications and cautions
- Hypersensitivity to anidulafungin or any formulation excipient.
- Hypersensitivity to another echinocandin.
- For the fructose-containing selected formulation, hereditary fructose intolerance generally precludes use unless there is an overwhelming clinical need and no alternative.
Monitoring
- Clinical and microbiological response, including culture clearance where applicable.
- Observe during infusion for anaphylaxis, rash, urticaria, bronchospasm, dyspnoea, flushing and hypotension.
- Liver tests; investigate rising hepatic enzymes or evidence of worsening hepatic function.
- Potassium, glucose and renal indices as clinically appropriate.
Clinical pharmacology
A semisynthetic echinocandin that selectively inhibits fungal beta-1,3-D-glucan synthase. It undergoes slow non-enzymatic degradation, has negligible renal clearance, is not dialysable and is not a clinically relevant cytochrome P450 substrate, inducer or inhibitor.
Formulation and product differences
- The selected product is a powder for concentrate that requires reconstitution and further dilution for intravenous infusion.
- It contains fructose and polysorbate 80 and is essentially sodium-free before dilution; sodium-containing diluent may contribute to total sodium exposure.
- Compatibility is established only with the specified sodium chloride or glucose infusion solutions; do not mix with other medicines or electrolytes.
anidulafungin preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 100 mg
anidulafungin interactions
Anidulafungin has a relatively low potential for cytochrome P450 interactions, but the full medicines list should still be reviewed.
Anaesthetic agents
Animal findings suggest anaesthesia may intensify infusion reactions; the clinical relevance is uncertain, so additional care is advised.
Ciclosporin, tacrolimus or voriconazole
Adult interaction studies did not show a clinically important pharmacokinetic interaction.
Amphotericin B or rifampicin
Adult studies did not identify a clinically important effect on anidulafungin exposure.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.