|Trade names||Eraxis, Ecalta, others|
|Other names||(4R,5S)-4,5-Dihydroxy-N2-[[4''-(pentyloxy)-p-terphenyl-4-yl]carbonyl]-L-ornithyl-L-threonyl-trans-4-hydroxy-L-prolyl-(S)-4-hydroxy-4-(p-hydroxyphenyl)-L-threonyl-L-threonyl-(3S,4S)-3-hydroxy-4-methyl-L-proline cyclic (6→1)-peptide|
|Main uses||Invasive candidiasis, esophageal candidiasis|
|Side effects||Diarrhea, nausea, low potassium|
|Bioavailability||100% (intravenous use only)|
|Protein binding||Extensive (>99%)|
|Metabolism||Liver metabolism not observed, CYP system not involved|
|Elimination half-life||27 hours; 40–50 hours (terminal)|
|Excretion||Feces (~30%), urine (<1%)|
|Chemical and physical data|
|Molar mass||1140.254 g·mol−1|
|3D model (JSmol)|
Common side effects include diarrhea, nausea, and low potassium. Other side effects may include liver problems and anaphylaxis. Use in pregnancy may harm the baby. It is an echinocandin and works by interfering with the production of a component of the fungal cell wall known as (1→3)-β-D-glucan.
Anidulafungin was approved for medical use in the United States in 2006 and Europe in 2007. It is available as a generic medication. It is on the World Health Organization's List of Essential Medicines as an alternative to micafungin. In the United Kingdom 100 mg costs the NHS about £300 as of 2021. This amount in the United States is about 200 USD.
- Candidemia and other forms of invasive Candida infections (intra-abdominal abscess and peritonitis)
- Esophageal candidiasis
Anidulafungin has not been studied in endocarditis, osteomyelitis, and meningitis due to Candida, and has not been studied in sufficient numbers of neutropenic patients to determine efficacy in this group.
Anidulafungin significantly differs from other antifungals in that it undergoes chemical degradation to inactive forms at body pH and temperature. Because it does not rely on enzymatic degradation or hepatic or renal excretion, the drug is safe to use in patients with any degree of hepatic or renal impairment.
Volume of distribution: 30–50 L.
Anidulafungin is not evidently metabolized by the liver. This specific drug undergoes slow chemical hydrolysis to an open-ring peptide which lacks antifungal activity. The half-life of the drug is 27 hours. About 30% is excreted in the feces (10% as unchanged drug). Less than 1% is excreted in the urine.
Mechanism of action
Anidulafungin inhibits glucan synthase, an enzyme important in the formation of (1→3)-β-D-glucan, a major fungal cell wall component. Glucan synthase is not present in mammalian cells, so it is an attractive target for antifungal activity.
Anidulafungin is manufactured via semisynthesis. The starting material is echinocandin B (a lipopeptide fermentation product of Aspergillus nidulans or the closely related species, A. rugulosus), which undergoes deacylation (cleavage of the linoleoyl side chain) by the action of a deacylase enzyme from the bacterium Actinoplanes utahensis; in three subsequent synthetic steps, including a chemical reacylation, the antifungal drug anidulafungin is synthesized.
Anidulafungin was originally discovered at Lilly laboratories by Turner and Debono and licensed to Vicuron Pharmaceuticals who submitted it to the FDA. Pfizer acquired the drug upon its acquisition of Vicuron in the fall of 2005. Pfizer gained approval by the Food and Drug Administration (FDA) on February 21, 2006.
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