Anidulafungin Dosing in Adults with Impaired Renal Function
No dose adjustment of anidulafungin is required for patients with any degree of renal impairment, including those on hemodialysis or continuous renal replacement therapy. 1
Standard Dosing Recommendations
For adults with invasive candidiasis/candidemia, regardless of renal function:
- Loading dose: 200 mg on day 1
- Maintenance dose: 100 mg daily thereafter 2
For esophageal candidiasis:
- Loading dose: 100 mg on day 1
- Maintenance dose: 50 mg daily thereafter 2
Pharmacokinetic Considerations in Renal Impairment
Anidulafungin has several pharmacokinetic properties that make it suitable for use in renal impairment:
- Negligible renal clearance (<1%) 1
- Not metabolized hepatically 1
- Not dialyzable - can be administered without regard to timing of hemodialysis 1
- Primarily eliminated through chemical degradation 1
Evidence in Patients with Renal Replacement Therapy
Multiple studies have confirmed the safety and efficacy of standard anidulafungin dosing in patients undergoing renal replacement therapies:
- In patients receiving continuous venovenous hemofiltration (CVVHF), pharmacokinetics resembled those of healthy adults and adults with fungal infections 3
- During continuous venovenous hemodiafiltration (CVVHDF), the influence on anidulafungin elimination was negligible 4
- In critically ill patients with septic shock undergoing CVVH, anidulafungin presented only mild pharmacokinetic changes 5
Clinical Considerations
When using anidulafungin in patients with renal impairment:
- Monitor for efficacy and adverse effects as with any patient
- The most common treatment-related adverse events include phlebitis/thrombophlebitis, headache, nausea, vomiting, and pyrexia 6
- Pharmacokinetics in critically ill ICU patients appear comparable to those in the general patient population 7
Advantages in Renal Impairment
Anidulafungin may offer advantages over other antifungals in patients with renal impairment:
- No dose adjustment required for any degree of renal impairment 1
- No drug interactions related to renal clearance
- No monitoring of renal function required specifically for anidulafungin dosing
Conclusion
Anidulafungin can be administered at standard doses to patients with any degree of renal impairment, including those on dialysis, without the need for dose adjustment. This makes it a convenient option for treating invasive candidiasis in patients with compromised renal function.