Anidulafungin
Also known as: Anidulafungin sodium, Cancidas, Ecalta, Eraxis, FK463, LY303366, VER-002
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Summary
Anidulafungin is an intravenously administered echinocandin antifungal approved for prescription use. It belongs to the lipopeptide class and is employed primarily as first‑line therapy for invasive Candida infections, including candidemia, where it has demonstrated superior clinical response compared with fluconazole in randomized studies.
Mechanism of Action
Anidulafungin acts by inhibiting the enzyme β‑(1,3)‑d‑glucan synthase, which catalyses the synthesis of β‑(1,3)‑d‑glucan, an essential component of the fungal cell wall. Disruption of glucan production weakens the wall, leading to osmotic instability and fungal cell death. Resistance can arise through mutations in the FKS1 or FKS2 genes that encode the glucan synthase target.
What the Research Shows
Clinical reviews highlight invasive fungal infection as a significant, often under‑detected problem, especially in immunocompromised patients. Randomised trials cited in a 2019 review reported a candidemia response rate of 75.6% for anidulafungin versus 60.2% for fluconazole, supporting its role as first‑line therapy for Candida spp. A 2022 review described the drug’s lipopeptide structure and its mechanism of glucan synthase inhibition, noting ongoing efforts to develop derivatives with improved properties. Resistance mechanisms, particularly FKS mutations, are summarised in a 2023 review of Candida species. Safety considerations are discussed in expert opinions on hepatic and renal toxicity, indicating that while hepatic effects can occur, echinocandins, including anidulafungin, have a lower nephrotoxic profile than amphotericin B.
Reported Benefits
Evidence from randomized trials shows higher clinical cure rates for candidemia compared with fluconazole, making anidulafungin a preferred first‑line option for invasive Candida infections. Its mechanism targets a cell‑wall component absent in human cells, contributing to selective antifungal activity. The drug’s intravenous formulation allows rapid systemic exposure, beneficial in critically ill patients.
Limitations of the Evidence
Resistance can develop through FKS1/FKS2 mutations, potentially reducing efficacy against certain Candida strains. The need for intravenous administration limits outpatient use and requires healthcare‑facility access. Data on efficacy for non‑Candida invasive fungi are limited, and the drug’s safety profile requires monitoring for hepatic dysfunction. Long‑term outcome data beyond acute treatment are sparse.
Safety Considerations
Anidulafungin may cause elevations in liver enzymes and, in rare cases, clinically significant hepatotoxicity; liver function should be monitored during therapy. Compared with amphotericin B, it has a relatively low risk of nephrotoxicity, but renal function should still be assessed in patients with pre‑existing kidney disease. Drug‑drug interactions are fewer than with azoles, yet clinicians should remain vigilant for additive hepatic effects when co‑administered with other hepatotoxic agents.
How It Is Administered
The compound is supplied for intravenous infusion only; no oral or other routes are approved. It is administered as a lipopeptide solution diluted in compatible IV fluids. Dosing regimens are determined by clinical guidelines and patient factors such as weight and renal or hepatic function, but specific dosing instructions are not provided here.
Routes of Administration
Goals & Uses
- Treatment of invasive candidiasis (intra-abdominal, peritonitis)Antifungal TherapyHigh
- Invasive candidiasis treatmentAntifungalHigh
- Empirical antifungal therapy in ICUAntifungal TherapyModerate
- Treatment of esophageal candidiasisAntifungal TherapyHigh
- Candida esophagitisAntifungalHigh
- Treatment of candidemiaAntifungal TherapyHigh
- Prophylaxis in high-risk patientsAntifungal ProphylaxisLow
Contraindications
- Hypersensitivity to polysorbate 80 (excipient)Excipient AllergyHigh
- Hypersensitivity to anidulafungin or any component of the formulationAllergyHigh
- Hypersensitivity to anidulafungin or other echinocandinsAllergyHigh
Adverse Effects
- Elevated liver enzymes (AST/ALT)HepatotoxicityCommon
- Elevated hepatic transaminases (ALT, AST)HepaticUncommon
- HypokalemiaElectrolyteRare
- Hepatic failureHepatotoxicityRare
- Infusion‑related reactions (flushing, rash, dyspnea)Infusion ReactionCommon
- Infusion-related reactions (flushing, hypotension, rash)Infusion ReactionUncommon
- Nausea/vomiting/diarrheaGastrointestinalCommon
- Deep vein thrombosis / phlebitisVascularUncommon
Drug Interactions
- Cytochrome P450 substratesLow
- CyclosporineLow
- VoriconazoleLow
- Concurrent hepatotoxic drugsModerate
- TacrolimusLow
Population Constraints
- PregnancyReproductive SafetyRelative
- Pediatric patientsAgeRelative
- Pediatric patients <3 monthsAgeRelative
- Pregnancy (Category C/unknown risk)PregnancyRelative
- BreastfeedingReproductiveRelative
- Elevated liver enzymes at baselineHepatic ImpairmentRelative
Regulatory Status
- European UnionApprovedApproved: invasive candidiasis, candidemia, candida esophagitisEMA approval; same indications as US
- United StatesApprovedApproved: invasive candidiasis, candidemia, candida esophagitisFDA approval 2001; marketed as Cancidas
- United KingdomApprovedApproved: Invasive candidiasis in adult non-neutropenic patientsApproved by MHRA (retained from EU approval); marketed as Ecalta
FDA‑approved (2001) as Cancidas for invasive candidiasis, candida esophagitis, and candidemia; EMA approved for similar indications.
Evidence & Sources
- Journal ArticleModeratevon Lilienfeld-Toal M, et al.2019-01-01T00:00:00.000000Z
- Journal ArticleModerateSzymański M, et al.2022-01-01T00:00:00.000000Z
- Journal ArticleModerateKyriakidis I, et al.2017-01-01T00:00:00.000000Z
- Journal ArticleModerateCzajka KM, et al.2023-01-01T00:00:00.000000Z
- Journal ArticleModerateTragiannidis A, et al.2021-01-01T00:00:00.000000Z
Frequently Asked Questions
What type of fungal infections is anidulafungin used to treat?
Anidulafungin is approved for invasive infections caused by Candida species, including bloodstream infections (candidemia). It is recommended as first‑line therapy for these infections based on clinical trial data showing higher response rates than fluconazole.
How does anidulafungin differ from azole antifungals?
Unlike azoles, which inhibit ergosterol synthesis, anidulafungin blocks β‑(1,3)‑d‑glucan synthase, targeting the fungal cell wall. This distinct mechanism reduces cross‑resistance with azoles and generally results in fewer drug‑drug interactions.
Are there concerns about liver or kidney damage with anidulafungin?
Both hepatic and renal adverse effects have been reported. Liver enzyme elevations occur and should be monitored, while nephrotoxicity is relatively low compared with amphotericin B but still warrants assessment in patients with existing kidney impairment.
Can resistance to anidulafungin develop?
Yes. Mutations in the FKS1 or FKS2 genes that encode the glucan synthase target can confer echinocandin resistance, potentially reducing the drug’s effectiveness against certain Candida strains.
Why is anidulafungin given only by IV infusion?
Anidulafungin is a large lipopeptide that is not absorbed orally. Intravenous delivery ensures adequate systemic concentrations, which is essential for treating severe, invasive fungal infections in hospitalized patients.
What is Anidulafungin?
Anidulafungin is an intravenously administered echinocandin antifungal approved for prescription use. It belongs to the lipopeptide class and is employed primarily as first‑line therapy for invasive Candida infections, including candidemia, where it has demonstrated superior clinical response compared with fluconazole in randomized studies.
What is Anidulafungin used for?
Anidulafungin is educationally associated with: Treatment of invasive candidiasis (intra-abdominal, peritonitis), Invasive candidiasis treatment, Empirical antifungal therapy in ICU, Treatment of esophageal candidiasis, Candida esophagitis, Treatment of candidemia, Prophylaxis in high-risk patients. Educational only — not medical advice.
How is Anidulafungin administered?
Recorded routes of administration: Intravenous.
What are the potential side effects of Anidulafungin?
Reported adverse effects include: Elevated liver enzymes (AST/ALT), Elevated hepatic transaminases (ALT, AST), Hypokalemia, Hepatic failure, Infusion‑related reactions (flushing, rash, dyspnea), Infusion-related reactions (flushing, hypotension, rash), Nausea/vomiting/diarrhea, Deep vein thrombosis / phlebitis. This list is not exhaustive — consult a qualified clinician.
Who should avoid Anidulafungin?
Recorded contraindications: Hypersensitivity to polysorbate 80 (excipient), Hypersensitivity to anidulafungin or any component of the formulation, Hypersensitivity to anidulafungin or other echinocandins. Consult a qualified clinician before use.