Anidulafungin
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 in Kucers’ The Use of Antibiotics, 2017
Anidulafungin (VER002, LY-303366; see Figure 148.1) is a semisynthetic echinocandin with broad antifungal activity against pathogenic yeasts and molds. The echinocandins were originally discovered as metabolic by-products of the fermentation process during screening programs for novel antibiotics. Anidulafungin is a derivative of the fermentation metabolite, echinocandin B0, produced by Aspergillus nidulans. The lead compound for anidulafungin was discovered in the 1970s (Benz et al., 1974) and developed at Eli Lily. The drug underwent clinical development at Vicuron Pharmaceuticals and received regulatory approval in 2006. Anidulafungin is now marketed under the brands Eraxis and Ecalta by Pfizer in the United States and Europe, respectively.
Antifungal management in risk groups: Solid organ transplant recipients
Mahmoud A. Ghannoum, John R. Perfect in Antifungal Therapy, 2019
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].
Anti-Infective Agents
Radhwan Nidal Al-Zidan in 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.
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.
Detection and treatment of Candida auris in an outbreak situation: risk factors for developing colonization and candidemia by this new species in critically ill patients
Published in Expert Review of Anti-infective Therapy, 2019
Alba Ruiz-Gaitán, Héctor Martínez, Ana María Moret, Eva Calabuig, María Tasias, Ana Alastruey-Izquierdo, Óscar Zaragoza, Joan Mollar, Juan Frasquet, Miguel Salavert-Lletí, Paula Ramírez, José Luis López-Hontangas, Javier Pemán
The susceptibility to echinocandins presented interesting features. These antifungals were not fungicidal against C. auris. In the case of caspofungin, most isolates presented a clear paradoxical growth after 24 h of incubation. As shown in Figure 1, fungal growth was inhibited at caspofungin concentrations around 0.5–1 mg/L, but it was recovered at concentrations of 4–16 mg/L. For anidulafungin and micafungin, increasing concentrations did not fully inhibit fungal growth after 24 h of incubation, and this residual growth was even more prominent after 48 h (Figure 1). Furthermore, echinocandins MIC values obtained after 48 h were significantly higher than those obtained at 24 h. For caspofungin, a significant proportion of the isolates that were susceptible at 24 h presented MICs of >16 mg/L after 48 h (supplemental Figure 1), which could be considered as fully resistant at this time reading. In the case of micafungin, a significant shift of the MIC distribution was also observed (supplemental Figure 1). For anidulafungin, while most MIC values at 24 h were low (0.015–0.06), a bimodal distribution was found after 48 h of incubation, finding a proportion of around 50% of the isolates with MIC values ranging between 0.5 and 2 mg/L (supplemental Figure 1).
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
Generally, echinocandins are well tolerated and have a promising safety profile compared to other antifungals. However, they may show some adverse effects. Micafungin may have a risk to develop possibly liver tumors [28]. Infusion associated reactions may happen after administration of echinocandins that can be managed using antihistamines [28]. Thrombophlebitis may especially take place in HIV infected patients. However, in patients with granulocytopenia and persistent fever, infusion-related reactions following administration of echinocandins were less than liposomal amphotericin [34]. Caspofungin has a greater incidence of liver-associated laboratory abnormalities (about 1 to 15%) compared to anidulafungin and micafungin [35]. In rare cases, administration of caspofungin may cause mild gastrointestinal symptoms such as vomiting, nausea diarrhea, and so on [28,36].
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