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Anti-Infective Agents
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: It is better to be avoided during the 1st Trimester because the pregnancy experience in humans is limited, and the reproduction studies in animals have shown the risk of teratogenicity associated with the use of Anidulafungin.
Antifungal management in risk groups: Solid organ transplant recipients
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Jasmine Chung, Sylvia F. Costa, Barbara D. Alexander
Anidulafungin is also well tolerated though hypokalemia, nausea, and diarrhea were the most common adverse events in one noninferiority study. Coadministration with cyclosporine caused elevation of the steady-state AUC of anidulafungin by 22% without affecting the Cmax, but the manufacturer does not recommend dose adjustment of either drug. Coadministration with tacrolimus did not result in alteration of either Cmax or AUC of either drug, and no dose adjustments are recommended. Coadministration with voriconazole also does not affect these parameters nor is dosage modification recommended [107–109,120,177–185].
Anidulafungin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Anidulafungin is indicated for the treatment of candidemia, other invasive Candida infections (intra-abdominal abscess, peritonitis) and esophageal candidiasis (Eraxis, 2008). In general, echinocandins should not be mixed with other medications unless the drug compatibility has been previously documented.
The safety profile of FLT3 inhibitors in the treatment of newly diagnosed or relapsed/refractory acute myeloid leukemia
Published in Expert Opinion on Drug Safety, 2021
Giovanni Marconi, Maria Benedetta Giannini, Gianmarco Bagnato, Giorgia Simonetti, Claudio Cerchione, Adrián Mosquera Orgueira, Gerardo Musuraca, Giovanni Martinelli
Midostaurin, gilteritinib, and quizartinib are metabolized by CYP3A4, and cytochrome isoform inhibitors augment their plasma level [44–46]. Azoles must be administered together with these drugs only if benefits for the patients outweigh possible risks. The interaction with azole could be severe, especially for midostaurin, which could have an unpredictable increase in plasma dose level and also cause pulmonary toxicity [43]. In this context, the best approach has to be established. A possible option could be to perform bi-weekly dosing of the FLT3 inhibitor and posaconazole plasma levels and to adjust drug dosages basing on test results. We usually use anidulafungin instead of posaconazole for patients at low risk of invasive fungal infection, together with a fast and interventionist diagnostic approach for possible infections. Some scores could be useful for a priori estimation of the risk of invasive fungal infections [47]. Particularly, for patients with a high risk of invasive fungal infection, the risk of combination toxicity must be pondered on the risk of severe infection. We recommend at least weekly testing of azole plasma level whenever concomitant administration of azole and FLT3 inhibitor could not be avoided or maybe convenient for the patients, together with intensive monitoring for toxicities (fast CT scan for respiratory symptoms, at least weekly electrocardiogram). International guidelines and consensus are highly warranted.
Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007–2016
Published in Infectious Diseases, 2019
Mari Ala-Houhala, Miia Valkonen, Elina Kolho, Nathalie Friberg, Veli-Jukka Anttila
Table 2 shows the antifungal susceptibilities. Fluconazole resistance among C. albicans isolates was rare (0.9%, 2/233) but high among the C. glabrata isolates (56.1%, 46/82) and increased among the latter isolates from 42.9% to 66.0% (p = .048) over the years. Only two C. parapsilosis isolates were fluconazole resistant (2/20, 10.0%). Resistance for anidulafungin was rare. No C. glabrata or C. albicans isolates, and only three C. parapsilosis and one C. tropicalis isolates were resistant to anidulafungin. Resistance rates for anidulafungin are shown only during the latter five-year period, because susceptibility testing for anidulafungin has been performed routinely only since 2011. Interpretation method of breakpoints has changed from CLSI to EUCAST during the study period, which might have influenced the susceptibility results.
Caspofungin: a review of its characteristics, activity, and use in intensive care units
Published in Expert Review of Anti-infective Therapy, 2020
Seyed MohammadReza Hashemian, Tayebeh Farhadi, Ali Akbar Velayati
Some patient populations including patients with severe organ dysfunction, critically ill, and burn patients are at risk of systemic inflammatory responses. In these populations, using of anidulafungin and caspofungin may be not safe and lead to hemodynamic-depressing effects. It may be due to high pharmacokinetic variability of the drugs that is associated to age, body surface area, disease severity, and body integrity [8,15,83,84]. Some practicing recommendations on using of caspofungin (and other echinocandins) in critical care units are summarized in Table 2.