Echinocandin Antifungal Pregnancy: Not recommended during pregnancy unless the benefit to the mother clearly outweighs the potential risk to the foetus (no human data; animal studies show reproductive toxicity). Unknown whether excreted in human milk; a risk to the suckling child cannot be excluded.

Anidulafungin

Brand names: Ecalta

Anidulafungin is an echinocandin antifungal used to treat invasive candidiasis, including candidaemia, in adults.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Single 200 mg loading dose on Day 1, then 100 mg maintenance dose daily

Route: IV infusion (rate not exceeding 1.1 mg/min; must not be given as a bolus)

Frequency: Loading dose once on Day 1, then 100 mg once daily

UK SPC (invasive fungal infections). Treatment should be initiated by a physician experienced in managing invasive fungal infections. Duration based on clinical response; in general antifungal therapy should continue for at least 14 days after the last positive culture. Insufficient data to support the 100 mg dose beyond 35 days of treatment. No dosing adjustment for any degree of hepatic impairment or for any degree of renal insufficiency (including dialysis; can be given without regard to timing of haemodialysis). No adjustment based on gender, weight, ethnicity, HIV positivity or elderly. (US label additionally: esophageal candidiasis — 100 mg loading dose Day 1 then 50 mg once daily maintenance.)

Paediatric dose

Dose: 1.5 mg/kg

Route: IV infusion

Frequency: Maintenance dose once daily (after loading dose)

Max: Loading dose not to exceed 200 mg; maintenance dose not to exceed 100 mg

Paediatric population 1 month to 18 years: single loading dose of 3.0 mg/kg (not to exceed 200 mg) on Day 1, followed by a daily maintenance dose of 1.5 mg/kg (not to exceed 100 mg) thereafter. Duration based on clinical response; generally continue at least 14 days after the last positive culture. Safety and efficacy NOT established in neonates (<1 month); not recommended in neonates. Verify against a children's formulary.

Dose adjustments

Renal

No dosing adjustment required for any degree of renal insufficiency, including patients on dialysis; can be given without regard to timing of haemodialysis.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Hypersensitivity to other medicinal products of the echinocandin class

Side effects

Diarrhoea, nausea (common)
Hypokalaemia (common)
Convulsion, headache (common)
Hypotension, hypertension (common)
Bronchospasm, dyspnoea, rash and pruritus (common; infusion-related)

Interactions

Cyclosporine — no significant alteration in pharmacokinetics of either drug; no dose adjustment needed (US label)
Voriconazole — no significant pharmacokinetic alteration; no dose adjustment needed (US label)
Tacrolimus — no significant pharmacokinetic alteration; no dose adjustment needed (US label)
Rifampin — no significant alteration in anidulafungin pharmacokinetics; no dose adjustment needed (US label)

Clinical monograph

How it works

It inhibits the enzyme 1,3-beta-D-glucan synthase, disrupting fungal cell wall synthesis and leading to fungal cell death.

Prescribing in practice

Infusion-related reactions can occur and the infusion rate should not be exceeded as specified in the SPC.
It has activity against Candida species, including many azole-resistant strains, but is not effective against Cryptococcus and has limited activity against some moulds.
It is administered intravenously and is generally well tolerated, with no dose adjustment required for renal impairment.

Monitoring

Monitor liver function and for infusion-related and hypersensitivity reactions during treatment.

Counselling the patient

Tell the team if you feel flushed, itchy or unwell during the infusion.
This medicine is given by a drip into a vein.
Report any new rash or signs of an allergic reaction.

Evidence & guidelines

Echinocandins including anidulafungin are recommended first-line for invasive candidiasis in current infection guidance.

Reference: IDSA Invasive Candidiasis Guidelines (2016 updated); ESCMID Candida Guidelines (2012); NICE TA540 (echinocandins); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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