ANIDULAFUNGIN

ANIDULAFUNGIN
(a-ni-dul'a-fun-gin)
Eraxis
Classifications: antibiotic; echinocandin antifungal;
Therapeutic:antifungal antibiotic
Prototype: Caspofungin
Pregnancy Category: C

Availability

50 mg powder for injection

Action

Anidulafungin is a semisynthetic echinocandin with antifungal activity. It inhibits glucan synthase, an enzyme present in fungal cells. Glucan is an essential component of the fungal cell wall; therefore, anidulafungin causes fungal cell death.

Therapeutic Effect

Anidulafungin interferes with reproduction and growth of susceptible fungi.

Uses

Treatment of candidemia and other Candida infections caused by C. albicans, C. glabrata, C. parapsilosis, and C. tropicalis. Treatment of esophageal candidiasis.

Unlabeled Uses

Fungal prophylaxis in immunocompromised children who are hospitalized with neutropenia.

Contraindications

Hypersensitivity to anidulafungin or another echinocandin antifungal agent; pregnancy (category C), lactation.

Cautious Use

Hepatic impairment. Safety and efficacy in children have not been established.

Route & Dosage

Candidemia and Other Candida Infections
Adult: IV 200 mg loading dose on day 1, then 100 mg IV daily for at least 14 d after last positive culture

For the Treatment of Esophageal Candidiasis
Adult: IV 100 mg loading dose on day 1, then 50 mg IV daily for at least 14 d (and for at least 7 d after resolution of symptoms)

Administration

Intravenous

PREPARE: IV Infusion: Reconstitute each vial with the supplied single-use 15 mL vial of diluent [20% (w/w) dehydrated alcohol in water] to yield 3.33 mg/mL. Each 50 mg reconstituted vial must be further diluted with NS for D5W to a total infusion volume of 100 mL with a concentration of 0.5 mg/mL. ??For a 50 mg dose, dilute 15 mL reconstituted solution in 100 mL of IV fluid to yield 0.43 mg/mL.??For a 100 mg dose, dilute 30 mL reconstituted solution in 250 mL of IV fluid to yield 0.36 mg/mL.??For a 200 mg dose, dilute 60 mL reconstituted solution in 500 mL of IV fluid to yield 0.36 mg/mL.

ADMINISTER: IV Infusion: Give at a rate no greater than 1.1 mg/min. DO NOT give a bolus dose.

INCOMPATIBILITIES Y-site: Amphotericin B, ertapenem, sodium bicarbonate.

Store unreconstituted vials, reconstituted vials, and companion diluent vials at 15° to 30° C (59°–86° F). Reconstituted vials must be further diluted and administered within 24 h.

Adverse Effects (≥1%)

Body as a Whole: Hypersensitivity. CNS: Headache. GI: Diarrhea, nausea. Hematologic: Neutropenia. Metabolic: Increased alkaline phosphatase, increased ALT, increased gamma-glutamyl transferase, hypokalemia. Skin: Rash.

Interactions

Drug: Cyclosporin increases overall systemic exposure (i.e., area under the curve, or AUC).

Pharmacokinetics

Distribution: 84% protein bound. Metabolism: Non-hepatic degradation to inactive metabolites. Elimination: Fecal. Half-Life: 40–50 h.

Nursing Implications

Assessment & Drug Effects

Prior to initiating therapy with anidulafungin, obtain specimen for fungal culture.
Monitor for and report S&S of hypersensitivity (e.g., dyspnea, flushing, hypotension, swelling about the face, pruritus, rash, and urticaria) or liver dysfunction (e.g., jaundice, clay-colored stools).
Discontinue infusion if signs of hypersensitivity appear.
Monitor cardiac status especially with a preexisting history of dysrhythmias.
Lab tests: Baseline and periodic liver function tests; periodic CBC with differential and platelet count; periodic serum electrolytes, amylase, and lipase.
Monitor for S&S hypokalemia and hepatic toxicity (see Appendix F).
Monitor diabetics for loss of glycemic control.

Patient & Family Education

Report any of the following immediately if experienced during or shortly after infusion: difficulty breathing, swelling about the face, itching, rash.
Report S&S of jaundice to the physician: clay-colored stool, dark urine, yellow skin or sclera, unexplained abdominal pain, or fatigue.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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