Echinocandins
Also known as: Caspofungin (Cancidas), Micafungin (Mycamine), Anidulafungin (Eraxis), Rezafungin (Rezzayo)
Cyclic lipopeptide antifungals (caspofungin, micafungin, anidulafungin, rezafungin) for invasive Candida infections. FDA-approved. Prescription only.
Last updated
Mechanism of Action
Echinocandins are semisynthetic cyclic lipopeptides that noncompetitively inhibit beta-(1,3)-D-glucan synthase. This enzyme makes a glucan polymer essential to the fungal cell wall and has no human equivalent, which accounts for their good tolerability. They kill most Candida species and inhibit Aspergillus growth. Resistance is linked to mutations in the FKS genes that encode the enzyme.
- Half-life
- Caspofungin ~9–11 h; micafungin ~15 h; anidulafungin ~1 day; rezafungin ~5–6 days
- Administration Routes
- Intravenous
- Research Status
- Clinical
Reported Benefits
- First-line treatment for candidemia and invasive candidiasis in most adults
- Treat esophageal candidiasis (caspofungin, micafungin, anidulafungin)
- Caspofungin is used for invasive aspergillosis in patients who can't tolerate other therapy and for suspected fungal infection in febrile neutropenia
- Rezafungin's long half-life allows once-weekly dosing
Potential Side Effects
- Liver enzyme elevations
- Infusion-related reactions (flushing, rash, itching)
- Fever, nausea and phlebitis
- Photosensitivity and tremor reported with rezafungin
Common Dosing
Echinocandins are given intravenously by clinicians, usually in hospital. Caspofungin, micafungin and anidulafungin are given once daily (often with a loading dose), and rezafungin once weekly. Doses vary by drug and indication; caspofungin is adjusted for liver impairment. The prescribing clinician sets and supervises dosing.
The dosing information above is aggregated from research literature and anecdotal community reports for educational purposes only. It is not a recommendation, prescription, or medical advice. Peptides are sold as research chemicals only and are not intended for human use.
Contraindications
- Known hypersensitivity to any echinocandin
- Caution in significant liver impairment
- Poor penetration into the eye, central nervous system and urine limits use for those sites
No documented stacking partners for Echinocandins yet.
- View
Comparison of caspofungin and amphotericin B for invasive candidiasis
2002
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Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial
2007
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Anidulafungin versus fluconazole for invasive candidiasis
2007
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Rezafungin versus caspofungin for treatment of candidaemia and invasive candidiasis (ReSTORE): a multicentre, double-blind, double-dummy, randomised phase 3 trial
2023