anidulafungin (Eraxis)

Indications

serious fungal infections

• fungal infections with candida
  • esophageal candidiasis
  • candidemia
• intra-abdominal abscess
• peritonitis

Contraindications

• aspergillosis

Pregnancy category: C

Dosage

(adults)

• candidemia, intra-abdominal abscess, peritonitis
  • 200 mg IV loading dose by infusion*, then
  • 100 mg daily for at least 14 days
  • continue for at least 14 days after last positive culture
• esophageal candidiasis
  • loading dose is 100 mg
  • daily dose is 50 mg for at least 14 days
  • continue for at least 7 days following resolution of symptoms

* infusion < 1.1 mg/min

lyophilized, preservative-free powder, 50 mg single-use vials.

diluent 15 mL of 20% [w/w] ethanol in water

dilute with D5W or normal saline to at least 100 mL/50 mg

use reconstituted solutions within 24 hours

Pharmacokinetics

• NOT a clinically relevant inducer or substrate of cyt P450
• negligible renal clearance

Adverse effects

• diarrhea (3.1%)
• hypokalemia (3.1%)
• elevated ALT (2.3%)
• headache (1.3%)
• increased GGT (1.3%)
• histamine-mediated symptoms (uncommon) rash, urticaria, flushing, pruritus, dyspnea, hypotension)
• adverse effect less frequent with infusion rate < 1.1 mg/min

Drug interactions

• no clinically relevant drug-drug interactions with: cyclosporine, voriconazole, tacrolimus, rifampin, liposomal amphotericin B, rifampin

• drug interaction(s) of antibiotics with warfarin

Mechanism of action

• echinocandin antifungal
• inhibits cell wall formation

Notes

$60/30 g (projected price 2006)

More general terms

• echinocandin

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=166548
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=460691