Information about Echinocandins
The echinocandins include anidulafungin, caspofungin, and micafungin and are a relatively new class of antifungal agents that are administered parenterally and are used in therapy or prevention of serious, invasive aspergillosis and candidal infections.
Liver safety of Echinocandins
All three agents can cause transient and asymptomatic serum aminotransferase elevations, and individual instances of acute liver injury have been observed during therapy with these agents, but none has been definitely shown to cause clinically apparent acute drug induced liver injury.
Mechanism of action of Echinocandins
The echinocandins are a relatively new class of antifungal agents, whose activity is due to inhibition of glucan synthetase, the enzyme that is responsible for synthesis of β-1, 3-D-glucan, an essential component of the cell wall of filamentous fungi, such as Aspergillus and Candida species. This enzyme inhibition results in alteration in the fungal membrane integrity, followed by cell ballooning and, for Candida cells, lysis. Three echinocandins are available for use: caspofungin (kas" poe fun' jin), micafungin (mye" ka fun' jin) and anidulafungin (ay nid" ue la fun' jin).
FDA approval information for Echinocandins
Caspofungin was approved for use in the United States in 2001, micafungin in 2005 and anidulafungin in 2006. All three are given intravenously and currently approved for therapy of esophageal candidiasis and for severe, disseminated or invasive candidiasis. Caspofungin is also approved for use as a secondary therapy of invasive aspergillosis and as empirical therapy for presumed fungal infection in febrile, neutropenic patients. Micafungin is also approved for prophylaxis against candidiasis in hematopoietic stem cell transplant recipients. Caspofungin is available under the brand name Cancidas in a formulation for intravenous use, the recommended dose in adults being 70 mg on the first day of treatment followed by 50 or 100 mg daily. Micafungin is available under the brand name of Mycamine in an intravenous formation, the recommended dosage being 50 mg daily for prophylaxis and 100 to 150 mg daily for therapy of candidemia. Anidulafungin is available under the brand name of Eraxis in intravenous formulations and the recommended dosage for disseminated candidal infection is 200 mg on day 1 followed by 100 mg daily. The echinocandins are administered intravenously in a slow infusion over one hour (to decrease the risk of acute infusion reactions).
Side effects of Echinocandins
Common side effects include phlebitis and the histamine-like reaction marked by rash, urticaria, flushing, bronchospam, hypotension and facial swelling.
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