Echinocandin Antifungal — Invasive Candidiasis / Candidaemia 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 intravenous 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 beta-1,3-glucan synthase, disrupting synthesis of an essential fungal cell-wall component and leading to osmotic instability and fungal cell death.

Prescribing in practice

Hypersensitivity and infusion-related reactions can occur, so the infusion rate should not exceed the recommended maximum to reduce histamine-mediated effects such as flushing and rash.
No dose adjustment is required for renal impairment or for mild to moderate hepatic impairment, as anidulafungin undergoes non-enzymatic degradation rather than hepatic metabolism.
Liver enzyme abnormalities have been reported, so hepatic function should be monitored if clinically indicated.

Monitoring

Monitor liver function tests and observe for infusion-related and hypersensitivity reactions during administration.

Counselling the patient

Report flushing, rash or itching during the infusion.
This medicine is given by a drip into a vein by trained staff.
Tell the team about any history of allergy to antifungal medicines.

Evidence & guidelines

Echinocandins such as anidulafungin are recommended as first-line therapy for invasive candidiasis and candidaemia in UK and international antifungal guidelines.

Reference: ESCMID Candida Guidelines 2012 (update 2020); IDSA Candidiasis Guidelines 2016; ASPECT-cSSSI Trial; 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.

Calculators

Pathways