Names and pronunciation
(a-nid-yoo-luh-fun′jin) Eraxis
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Drug reference
(a-nid-yoo-luh-fun′jin) Eraxis
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Func. class.: Antifungal, systemic
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Chem. class.: Echinocandin
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ACTION: Inhibits fungal enzyme synthe- sis; causes direct damage to fungal cell wall
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USES: Esophageal candidiasis, Can dida albicans, C. glabrata, C. parapsi losis, C. tropicalis
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CONTRAINDICATIONS: Hyper- sensitivity to product, other echinocandins Precautions: Pregnancy, breastfeeding, children, severe hepatic disease
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SIDE EFFECTS CNS: Dizziness, fever, headache, depression CV: DVT, hypotension, chest pain, edema GI: Nausea, anorexia, vomiting, diarrhea META: Hypokalemia RESP: Dyspnea, cough HEMA: Anemia, thrombocytopenia INTEG: Rash, urticaria, itching, flushing META: Hyperkalemia GU: UTI EENT: Oral candidiasis MS: Back pain
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INTERACTIONS None known Drug/Lab Test Increase: amylase, bilirubin, creatinine, lipase, PT, alkaline phosphatase, AST, ALT Decrease: Magnesium, potassium, glucose
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DOSAGE AND ROUTES Candidemia and other Candida infections • Adult: IV 200-mg loading dose on day 1, then 100 mg/day, continue treatment for 2 weeks after documented clearance of Candida from bloodstream and resolu- tion of symptoms Esophageal candidiasis • Adult: IV 200 mg/day × 14-21 days
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Available forms: Powder for injection, lyophilized 50 mg/vial, 100 mg/vial for IV use
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Administer: IV route • Obtain C&S tests before starting treat- ment • Visually inspect prepared infusions for particulate matter and discoloration, do not use if present; give by IV infusion only, after dilution • Reconstitution: Reconstitute each 50-mg or 100-mg vial/15 mL or 30 mL of sterile water for injection, respectively (3.33 mg/mL) • Storage: Reconstituted solutions are stable for up to 24 hr at room temperature • Dilution: Do not use any other diluents A besides D5W or sodium chloride 0.9% (NS) • Preparation of the 100-mg daily infusion: Withdraw the contents of one 100-mg reconstituted vial OR two 50-mg reconstituted vials and add to an IV infu- sion bag or bottle containing 100 mL of D5W or NS to give a total infusion volume of 130 mL • Preparation of a 50-mg daily infusion: Withdraw the contents of one 50-mg reconstituted vial and add to an IV infu- sion bag or bottle containing 50 mL of D5W or NS to give a total infusion volume of 65 mL • Storage: Diluted solutions are stable for up to 48 hr at temperatures up to 77°F (25°C) or for 72 hr if stored frozen Intermittent IV Infusion • Do not mix or co-infuse with other medications • Administer as a slow IV infusion at a rate of 1.4 mL/min or 84 mL/hr; the minimum duration of infusion is 180 min for the 200-mg dose, 90 min for the 100- mg dose, and 45 min for the 50-mg dose • Store reconstituted vials at 59°F-86°F (15°C-30°C) for up to 24 hr, do not freeze (dehydrated alcohol); store re- constituted vials at 36°F-46°F (2.2°C- 7.7°C) (sterile water) for up to 24 hr, do not freeze Y-site compatibilities: Acyclovir, alem- tuzumab, alfentanil, allopurinol, amifos- tine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphoteri- cin B lipid complex, amphotericin B liposome, ampicillin, ampicillin sulbac- tam, argatroban, arsenic trioxide, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOpla- tin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXi- tin, cefTAZidime, ceftizoxime, cefTRIAX- one, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxa- cin, cisatracurium, CISplatin, clindamy- cin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAUNOrubicin liposome, DAUNOrubicin hydrochloride, dexamethasone, dexme- detomidine, dexrazoxane, digoxin, diltia- zem, diphenhydrAMINE, DOBUtamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPI- NEPHrine, epiRUBicin, eptifibatide, eryth- romycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluo- rouracil, foscarnet, fosphenytoin, furose- mide, gallium nitrate, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, IDAru- bicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinote- can, isoproterenol, ketorolac, labetalol, leucovorin, levoFLOXacin, lidocaine, linezolid injection, LORazepam, manni- tol, mechlorethamine, melphalan, meperidine, meropenem, mesna, meta- raminol, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mid- azolam, milrinone, mitoMYcin, mitoXAN- TRONE, mivacurium, morphine, moxi- floxacin, mycophenolate mofetil, nafcillin, naloxone, nesiritide, niCARdipine, nitro- glycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantopra- zole, PEMEtrexed, pentamidine, pentazo- cine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, piperacillin/ tazobactam, polymyxin B, potassium ace- tate/chloride, procainamide, prochlor- perazine, promethazine, propranolol, quiNIDine, quinupristin-dalfopristin, raNITIdine, remifentanil, rocuronium, sodium acetate, streptozocin, succinyl- choline, SUFentanil, sulfamethoxazole- trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticar- cillin, ticarcillin/clavulanate, tirofiban, tobramycin, topotecan, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
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Assess: • Infection: clearing of cultures during treatment; obtain culture at baseline and throughout treatment; product may be started as soon as culture is taken, those with HIV pharyngeal candidiasis may need additional antifungals • Hepatic studies before, during treat- ment: bilirubin, AST, ALT, alkaline phos- phatase, as needed; also uric acid • GI symptoms: frequency of stools, cramping; if severe diarrhea occurs, electrolytes may need to be given
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Evaluate: • Therapeutic response: decreased symp- toms of Candida infection, negative culture
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • The reason for product, expected result • Anaphylaxis: To report anaphylaxis symptoms immediately • Pregnancy/breastfeeding: to notify prescriber if pregnancy is suspected, planned; to avoid breastfeeding
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PHARMACOKINETICS Steady state after loading dose, half-life 40-50 hr, protein binding 99%, crosses placenta, no metabolism, onset up to 24 hr
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• Adult: IV 200-mg loading dose on day 1, then 100 mg/day, continue treatment for 2 weeks after documented clearance of Candida from bloodstream and resolu- tion of symptoms Esophageal candidiasis
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• Adult: IV 200 mg/day × 14-21 days
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