Dosing & Uses
Dosage Forms & Strengths
injection, lyophilized powder for reconstitution
- 50mg/vial
- 100mg/vial
Candidemia
Indicated for treatment of candidemia and intra-abdominal abscess and peritonitis caused by Candida infections
Day 1: 200 mg IV infusion, THEN
Day 2 and thereafter: 100 mg/day IV
Generally continue 14 days after last positive culture
Esophageal Candidiasis
Indicated for treatment of esophageal candidiasis
Day 1: 100 mg IV infusion, THEN
Day 2 and thereafter: 50 mg/day IV
Minimum 14 day treatment, at least 7 days following resolution of symptoms
Owing to risk of relapse of esophageal candidiasis in patients with HIV infection, consider suppressive antifungal therapy after treatment course
Candida auris (Off-label)
Based on the limited data, an echinocandin drug (eg, anidulafungin, caspofungin, micafungin) is recommended by the CDC as initial therapy for treatment of C auris infections
Day 1: 200 mg IV
Day 2 and thereafter: 100 mg IV qDay
For more information, see CDC Candida auris Treatment and Management
Dosage Modifications
Any degree of hepatic or renal insufficiency: No dosage adjustments required
Not dialyzable; may be administered without regard to hemodialysis timing
Dosing Considerations
Obtain specimens for fungal culture before initiating empiric antifungal treatment; adjust regimen according to results
Limitations of use
- Not studied in adults and children with endocarditis, osteomyelitis, and meningitis due to Candida
- Not studied in sufficient numbers of neutropenic patients to determine efficacy
- Dosage not established for treatment of Candida with dissemination into the CNS and eye
- Associated with high relapse rates in esophageal candidiasis
Dosage Forms & Strengths
injection, lyophilized powder for reconstitution
- 50mg/vial
- 100mg/vial
Candidemia
Indicated for treatment of candidemia and intra-abdominal abscess and peritonitis caused by Candida infections in pediatric patients aged ≥1 month
Day 1: 3 mg/kg (not to exceed 200 mg/dose) IV infusion, THEN
Day 2 and thereafter: 1.5 mg/kg (not to exceed 100 mg/dose) IV
Generally continue 14 days after last positive culture
Candida auris (Off-label)
Based on the limited data, an echinocandin drug (eg, anidulafungin, caspofungin, micafungin) is recommended by the CDC as initial therapy for treatment of C auris infections in adults and children aged 2 months or older
Day 1: 200 mg IV
Day 2 and thereafter: 100 mg IV qDay
For more information, see CDC Candida auris Treatment and Management
Dosage Modifications
Any degree of hepatic or renal insufficiency: No dosage adjustments required
Not dialyzable; may be administered without regard to hemodialysis timing
Dosing Considerations
Obtain specimens for fungal culture before initiating empiric antifungal treatment; adjust regimen according to results
Limitations of use
- Not studied in adults and children with endocarditis, osteomyelitis, and meningitis due to Candida
- Not studied in sufficient numbers of neutropenic patients to determine efficacy
- Dosage not established for treatment of Candida with dissemination into the CNS and eye
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Adverse Effects
1-10%
Adults (candidemia)
- Hypokalemia (25%)
- Nausea (24%)
- Diarrhea (18%)
- Pyrexia (18%)
- Hypotension (15%)
- Insomnia (15%)
- Hypertension (12%)
- Dyspnea (12%)
- Increased alkaline phosphatase (12%)
- Hypomagnesemia (12%)
- Peripheral edema (11%)
Pediatric (candidemia)
- Pyrexia (18%)
- Diarrhea (16%)
- Vomiting (16%)
1-10%
Adults (candidemia)
- Deep vein thrombosis (10%)
- Pleural effusion (10%)
- Anemia (9%)
- Constipation (8%)
- Increased WBCs (8%)
- Confusional state (8%)
- Headache (8%)
- Cough (7%)
- Hypoglycemia (7%)
- Hyperkalemia (6%)
- Hyperglycemia (6%)
- Dehydration (6%)
- Respiratory distress (6%)
- Abdominal pain (6%)
- Depression (6%)
- Thrombocythemia (6%)
- Leukocytosis (5%)
- Chest pain (5%)
- Increased hepatic enzymes (5%)
- Increased blood creatinine (5%)
- Back pain (5%)
Adults (esophageal candidiasis)
- Diarrhea (9%)
- Pyrexia (9%)
- Anemia (8%)
- Headache (8%)
- Nausea (7%)
- Dyspepsia (7%)
- Vomiting (7%)
- Hypokalemia (5%)
- Oral candidiasis (5%)
-
Adults esophageal candidiasis <2%
- Blood and lymphatic: Coagulopathy, thrombocytopenia
- Cardiac: Atrial fibrillation, bundle branch block (right), sinus arrhythmia, ventricular extrasystoles
- Eye: Eye pain, vision blurred, visual disturbance
- General and administration site: Infusion related reaction, peripheral edema, rigors
- Hepatobiliary: Abnormal liver function tests, cholestasis, hepatic necrosis
- Infections: Clostridial infection
- Investigations: Amylase increased, bilirubin increased, CPK increased, electrocardiogram QT prolonged, GGT increased, lipase increased, potassium decreased, prothrombin time prolonged, urea increased
- Nervous system: Convulsion, dizziness
- Respiratory, thoracic and mediastinal: Cough
- Skin and subcutaneous tissue: Angioneurotic edema, erythema, pruritus, sweating increased, urticaria
- Vascular: Flushing, hot flushes, thrombophlebitis superficial
Pediatric (candidemia)
- Anemia (10%)
- Abdominal pain (9%)
- Epistaxis (9%)
- Rash (9%)
- ALT increased (9%)
- AST increased (6%)
- Thrombocytopenia (6%)
- Hypoglycemia (6%)
-
Pediatric <5%
- Blood and lymphatic system disorders: Pancytopenia, thrombocytosis, febrile neutropenia, leukopenia, neutropenia
- Eye disorders: Periorbital edema
- Gastrointestinal disorders: Gastroesophageal reflux disease, abdominal distension, nausea, stomatitis, dry mouth
- General disorders and administrative site conditions: Chest pain, edema peripheral
- Infections and infestations: Bacteremia, device related infection, gastroenteritis, lower respiratory tract infection, upper respiratory tract infection, urinary tract infection
- Laboratory investigations: GGT increased, transaminases increased
- Metabolism and nutrition disorders: Hypocalcemia, hypokalemia, hyponatremia, hypoproteinemia
- Musculoskeletal and connective tissue disorders: Back pain, pain in extremity
- Nervous system disorders: Headache, tremor, seizure
- Psychiatric disorders: Agitation
- Respiratory, thoracic and mediastinal disorders: Hemoptysis
- Vascular disorders: Hypotension
Warnings
Contraindications
Hypersensitivity to any component or other echinocandins
Known or suspected hereditary fructose intolerance
Cautions
Abnormal LFTs observed; if elevated liver tests develop, monitor for evidence of worsening hepatic tests and evaluate risk benefit of continuing anidulafungin monitor for potential hepatic problems
Anaphylactic reactions, including shock, reported; discontinue and initiate appropriate treatment if this occurs
Infusion-related adverse reactions (possibly histamine-mediated) reported, including rash, urticaria, flushing, pruritus, bronchospasm, dyspnea, and hypotension; reduce risk by not exceeding recommended infusion rate
Contains polysorbate 80, an inactive ingredient; thrombocytopenia, renal dysfunction, hepatomegaly, cholestasis, ascites, hypotension, and metabolic acidosis reported in low-birth weight infants receiving high doses of polysorbate; toxicity has not been reported with anidulafungin
Contains fructose; may precipitate a metabolic crisis (eg, life-threatening hypoglycemia, hypophosphatemia, lactic acidosis, hepatic failure) in patients with hereditary fructose intolerance
Pregnancy & Lactation
Pregnancy
Based on findings from animal studies, therapy can cause fetal harm when administered to pregnant females; there are no available human data on use in pregnant females to inform a drug-associated risk of adverse developmental outcomes
Animal studies
- Fetal toxicity observed in animal reproduction studies in the presence of maternal toxicity when anidulafungin was administered to pregnant rabbits during organogenesis at 4 times the proposed therapeutic maintenance dose of 100 mg/day (dose based on relative body surface area)
Lactation
There are no data on presence of drug in human milk, effects on breastfed infant or on milk production
Drug found in milk of lactating rats; when a drug is present in animal milk, it is likely that the drug will be present in human milk
Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Echinocandin - inhibits synthesis of 1,3-beta-D-glucan, an essential component of fungal cell walls
Absorption
Peak plasma concentration
- 70mg/35mg: 3.55 mg/L
- 200mg/100mg: 8.6 mg/L
AUC
- 70mg/35mg: 42.3 mg⋅hr/L
- 200mg/100mg: 111.8 mg⋅hr/L
Distribution
Distribution half-life: 30-60 minutes
Protein bound: >99% (plasma proteins)
Vd: 30-50 L
Metabolism
Not metabolized by liver
Undergoes slow chemical degradation to peptide lacking antifungal activity
Degradation half-life: ~24 hr
Elimination
Excretion: Feces (30% over 9 days [<10% intact drug]); urine (<1%)
Terminal half-life
- 70mg/35mg: 43.2 hr
- 200mg/100mg: 52 hr
Clearance
- 70mg/35mg: 0.84 L/hr
- 200mg/100mg: 0.94 L/hr
Administration
IV Preparation
Reconstitute lyophilized powder
- Reconstitute vial with sterile water for injection (SWI)
- 50-mg vial: Add 15 mL SWI to provide concentration of 3.33 mg/mL
- 100-mg vial: Add 30 mL SWI to provide concentration of 3.33 mg/mL
Further dilution required
- Adults: Aseptically transfer contents from reconstituted vial(s) to appropriately sized IV bag/bottle of D5W or 0.9% NaCl
-
Pediatric patients
- Infusion solution volume required is dependent on child’s weight
- Reconstituted solution must be further diluted to 0.77 mg/mL for final infusion solution
- See prescribing information for how to calculate dilution for doses <50 mg
IV Administration
Visually inspect solution for particulate matter and discoloration; if identified, discard solution
IV infusion rate: Not to exceed 1.1 mg/min
Do not give as IV bolus
Storage
Unopened vials: Store at 25°C (77°F)
Reconstituted vials: May store at 25°C (77°F) for up to 24 hr
Diluted solution: May store at 25°C (77°F) for up to 48 hr
Do not freeze
Images
Patient Handout
Formulary
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