anidulafungin
Brand: Eraxis
Prototype: caspofungin
Drug Class: echinocandin antifungal
Drug Family: antifungal
Subclass: echinocandin with unique elimination pathway
Organ Systems: infectious-disease
Mechanism of Action
Inhibits 1,3-beta-D-glucan synthase; uniquely eliminated by slow chemical degradation in blood rather than hepatic metabolism, making it the preferred echinocandin for patients with hepatic dysfunction.
fungal 1,3-beta-D-glucan synthase
Indications
- invasive candidiasis/candidemia
- esophageal candidiasis
Contraindications
- echinocandin hypersensitivity
Adverse Effects
Common
- histamine-related reactions during infusion (flushing, rash)
- nausea
- elevated LFTs
Serious
- hepatotoxicity (less than caspofungin/micafungin)
- anaphylaxis (rare)
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | widely distributed |
| Metabolism | slow chemical degradation in blood to inactive peptide — NO hepatic metabolism and NO CYP involvement |
| Excretion | fecal (<1% unchanged); chemical degradation products excreted primarily fecal |
| Half-life | 40–50 hours |
| Onset | immediate (IV) |
| Peak | end of infusion |
| Duration | 24 hours |
| Protein Binding | >99% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| cyclosporine | minimal; slight increase in anidulafungin AUC — no dose adjustment needed | minor |
Nursing Considerations
- Administer at a rate ≤1.1 mg/min to reduce histamine-mediated infusion reactions.
- No hepatic dose adjustment needed — a key advantage in patients with liver failure.
- No drug interactions with CYP enzymes — the safest echinocandin for polypharmacy patients.
- Monitor LFTs periodically; hepatotoxicity risk is lower than with other echinocandins.
Clinical Pearls
- Anidulafungin is the only antifungal that undergoes purely chemical degradation (not enzymatic/hepatic) for elimination, making it the echinocandin of choice in patients with severe hepatic dysfunction where other antifungals accumulate.
- The clinical equivalence of all three echinocandins for invasive candidiasis treatment means the selection can be driven entirely by patient-specific factors such as drug interactions, hepatic function, and formulary availability.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.