Eraxis
anidulafungin
Pharmacologic class: Semisynthetic echinocandin
Therapeutic class: Antifungal
Pregnancy risk category C
Action
Inhibits glucan synthase, an enzyme present in fungal (but not mammalian) cells; this action inhibits formation of 1,3-beta-D-glucan, an essential component of fungal cell wall.
Availability
Powder for injection (lyophilized): 50-mg single-use vial
Indications and dosages
➣ Candidemia and other Candida infections (intra-abdominal abscess, peritonitis)
Adults: Single 200-mg loading dose by I.V. infusion on day 1, followed by 100 mg I.V. daily thereafter. Duration depends on clinical response; generally, therapy continues at least 14 days after last positive culture.
➣ Esophageal candidiasis
Adults: Single 100-mg loading dose by I.V. infusion on day 1, followed by 50 mg I.V. daily thereafter. Treatment should continue for at least 14 days, and for at least 7 days after symptoms resolve; duration depends on clinical response. Due to risk of esophageal candidiasis relapse in patients with human immunodeficiency virus, suppressive antifungal therapy may be considered after treatment ends.
Contraindications
• Hypersensitivity to drug, its components, or other echinocandins
Precautions
Use cautiously in:
• hepatic impairment
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
Administration
See Don't give by I.V. bolus.
• Reconstitute only with supplied diluent (20% dehydrated alcohol in water for injection).
• Further dilute only with 5% dextrose injection or normal saline solution, to yield infusion solution concentration of 0.5 mg/ml.
• Give by I.V. infusion within 24 hours of reconstitution.
See Don't infuse at a rate exceeding 1.1 mg/minute.
• Don't dilute with other solutions or infuse through same I.V. line with other drugs or electrolytes.
Adverse reactions
CNS: headache
CV: hypotension, phlebitis
GI: aggravated dyspepsia, nausea, vomiting
Hematologic: neutropenia, leukopenia
Respiratory: dyspnea
Skin: rash, urticaria, pruritus, flushing
Other: fever
Interactions
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase: increased
Patient monitoring
• If patient has abnormal liver function tests during therapy, monitor for evidence of worsening hepatic function and weigh risks and benefits of continuing therapy.
• Monitor for rash, urticaria, flushing, dyspnea, and hypotension. (However, these are rare when drug is administered slowly.)
Patient teaching
See Instruct patient to report rash, itching, unusual bruising or bleeding, unusual tiredness, or yellowing of skin or eyes.
• Advise patient to report troublesome side effects such as GI upset.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the tests mentioned above.
anidulafungin
(a-ni-du-la-fun-gin) anidulafungin,Eraxis
(trade name)Classification
Therapeutic: antifungalsPharmacologic: echinocandins
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IV | rapid | end of infusion | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Respiratory
- bronchospasm
- dyspnea
Cardiovascular
- hypotension
Gastrointestinal
- diarrhea
- ↑ liver enzymes
Dermatologic
- flushing
- rash
- urticaria
Fluid and Electrolyte
- hypokalemia
Miscellaneous
- anaphylaxis (life-threatening)
- infusion reaction
Interactions
Drug-Drug interaction
None noted.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Assess infected area and monitor cultures before and periodically during therapy.
- Specimens for culture should be taken before instituting therapy. Therapy may be started before results are obtained.
- Monitor for signs and symptoms of anaphylaxis (rash, urticaria, flushing, pruritus, bronchospasm, dyspnea, hypotension); usually related to histamine release. To decrease risk, do not exceed a rate of infusion of 1.1 mg/minute.
- Lab Test Considerations: May cause ↑ ALT, AST, alkaline phosphatase, and hepatic enzymes.
- May cause hypokalemia.
- May cause neutropenia and leukopenia.
Potential Nursing Diagnoses
Risk for infection (Indications)Implementation
Intravenous Administration
- pH: 4.5–4.6.
- Intermittent Infusion: Reconstitute each 50 mg vial with 15 mL or the 100 mg vial with 30 mL of Sterile Water for Injection for a concentration of 3.33 mg/mL. May be stored in refrigerator for up to 1 hr. Diluent: Further dilute within 24 hr by transferring contents of reconstituted vial into IV bag of D5W or 0.9% NaCl. For the 50 mg dose, dilute with 85 mL for an infusion volume of 100 mL. For the 100 mg dose, dilute with 170 mL for an infusion volume of 200 mL. For the 200 mg dose, dilute with 340 mL for a total infusion volume of 400 mL.Concentration: Final concentration should not exceed 0.5 mg/mL. Do not administer solutions that are discolored or contain particulate matter. Store reconstituted solution in refrigerator; do not freeze. Administer within 24 hr.
- Rate: Administer at a rate not to exceed 1.1 mg/min (1.4 mL/min or 84 mL/hr).
- Y-Site Compatibility: acyclovir, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, argatroban, aresnic trioxide, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, bulsulfan, butorphanol, calcium chloride, calcium gulconate, carboplatin, carmustine, casopfungin, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daunorubicin hydrochloride, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, doxacurium, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydralazine, hydrocortisone, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, linezolid, lorazepam, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, mycophenolate, nafcillin, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate, streptozocin, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tirofiban, tobramycin, topotecan, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: amphotericin B colloidal, dantrolene, diazepam, ertapenem, magnesium sulfate, nalbuphine, pemetrexed, phenytoin, potassium phosphates, sodium bicarbonate, sodium phosphates
Patient/Family Teaching
- Explain purpose of medication to patient.
- Instruct patient to notify health care professional if signs and symptoms of anaphylaxis occur or if diarrhea becomes pronounced.
Evaluation/Desired Outcomes
- Resolution of clinical and laboratory indications of fungal infections. Duration of therapy should be based on the patients clinical response. Therapy should be continued for at least 14 days after the last positive culture. For esophageal candidiasis, treatment should continue for at least 7 days following resolution of symptoms.