[Pharmacokinetics and pharmacodynamics: interactions and adverse effects. Comparison with other echinocandins]

Enferm Infecc Microbiol Clin. 2008 Dec:26 Suppl 14:14-20. doi: 10.1016/s0213-005x(08)76588-1.
[Article in Spanish]

Abstract

New drugs will soon be incorporated into the echinocandin class of antifungals. The first to be released on to the market will be anidulafungin. The pharmacokinetic characteristics of this drug clearly distinguish it from the only representative of this family of antifungal agents available to date: caspofungin. Specifically, this new drug has a greater volume of distribution, a higher elimination half-life and, moreover, an elimination system -- spontaneous degradation --, thus avoiding interactions with other drugs and allowing its use without dosage adjustments in patients with renal or liver impairment. These are the main pharmacological differences between anidulafungin and caspofungin, since the latter requires dosage adjustments in patients with hepatic insufficiency, in patients under treatment with inducers of cytochrome P450 activity and in obese patients. Moreover, plasma concentration monitoring is recommended in patients requiring caspofungin who are also under treatment with cyclosporin A or tacrolimus. Clinical experience suggests that there are few differences in the tolerability profiles of the two drugs, both of which are excellent.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Aged
  • Anidulafungin
  • Antifungal Agents / adverse effects
  • Antifungal Agents / blood
  • Antifungal Agents / pharmacokinetics
  • Antifungal Agents / pharmacology*
  • Caspofungin
  • Chemical and Drug Induced Liver Injury / etiology
  • Drug Interactions
  • Drug Monitoring
  • Echinocandins / adverse effects
  • Echinocandins / blood
  • Echinocandins / pharmacokinetics
  • Echinocandins / pharmacology*
  • Echinocandins / therapeutic use
  • Gastrointestinal Diseases / chemically induced
  • Half-Life
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / pharmacology
  • Lipopeptides
  • Liver / drug effects
  • Liver / enzymology
  • Liver Failure / complications
  • Liver Failure / metabolism
  • Mycoses / complications
  • Mycoses / drug therapy*
  • Obesity / complications
  • Obesity / metabolism
  • Renal Insufficiency / complications
  • Renal Insufficiency / metabolism
  • Tissue Distribution

Substances

  • Antifungal Agents
  • Echinocandins
  • Immunosuppressive Agents
  • Lipopeptides
  • Anidulafungin
  • Caspofungin