Anidulafungin
An echinocandin that beat fluconazole for invasive candidiasis
Anidulafungin is a semi-synthetic cyclic lipopeptide echinocandin that blocks the fungal cell-wall enzyme beta-(1,3)-D-glucan synthase. Approved as Eraxis in 2006, it is given by daily intravenous infusion for candidaemia and esophageal candidiasis, and it is broken down chemically in the blood rather than by the liver.
What is it?
Anidulafungin is an echinocandin, a cyclic lipopeptide antifungal. Unusually for a drug, it is not metabolised by the liver: it degrades slowly by itself in blood to an inactive ring-opened peptide, which avoids many liver-related drug interactions. Its terminal half-life is 40 to 50 hours.
In a 2007 trial in 245 patients with invasive candidiasis, mostly candidaemia, treatment succeeded in 75.6% on anidulafungin against 60.2% on fluconazole, a 15.4-point difference. In 601 patients with esophageal candidiasis it matched oral fluconazole, with endoscopic success of 97.2% against 98.8%.
FDA approved it as Eraxis on February 17, 2006; the label now covers children from 1 month for candidaemia. Warnings cover liver reactions, anaphylaxis and hypersensitivity, polysorbate toxicity in newborns, and hereditary fructose intolerance. Like the other echinocandins it can only be given intravenously, after a loading dose on the first day.
At a Glance
Every value in this table is printed from the Grey Peptides dataset, the same record the compound explorer and comparison tool read, so the three can never disagree.
Half-Life: How Much Remains
The dataset records a half-life of terminal half-life 40 to 50 hours for Anidulafungin. After each half-life, half of what was in the circulation is gone, so about 3% remains after five. Real clearance varies with the person, the dose, the route and kidney or liver function; this is arithmetic on a published figure, not a dosing tool.
Published Research
The trials behind anidulafungin, from their PubMed abstracts.
Against fluconazole for invasive candidiasis
In 245 patients, 89% with candidaemia only, treatment success at the end of intravenous therapy was 75.6% on anidulafungin against 60.2% on fluconazole (difference 15.4 points, 95% CI 3.9 to 27.0).
Esophageal candidiasis
In 601 patients, endoscopic success was 97.2% on intravenous anidulafungin and 98.8% on oral fluconazole, meeting noninferiority; treatment-related adverse events were 9.3% against 12.0%.
Children aged 2 to 17
In an open-label study of 49 children with invasive candidiasis, all had at least one treatment-emergent adverse event (most often vomiting, diarrhoea and fever), 4 stopped for drug-related events, and all-cause mortality was 14.3% by week 6.
Side Effects & Contraindications
Reported Side Effects
From the studies above.
Contraindications & Cautions
Warnings from the Eraxis label (DailyMed, effective August 19, 2025).
Legal Status
Anidulafungin is an approved prescription drug in the US.
Frequently Asked Questions
?Is anidulafungin a peptide?
Yes. It is a cyclic lipopeptide echinocandin, a ring of amino acids with a fatty side chain.
?How is anidulafungin different from other echinocandins?
It is not broken down by the liver; it degrades chemically in blood. Rezafungin, a newer echinocandin, is a structural analogue designed to last long enough for weekly dosing.
?Was anidulafungin better than fluconazole?
In a 2007 trial of invasive candidiasis, treatment success was 75.6% on anidulafungin against 60.2% on fluconazole.
?Can anidulafungin be taken by mouth?
No. Echinocandins are not absorbed from the gut, so anidulafungin is given only by intravenous infusion, with a loading dose on the first day.
?Is anidulafungin approved for children?
Yes, for candidaemia and other Candida infections in children 1 month and older. In an open-label study of 49 children aged 2 to 17, all had at least one adverse event, most often vomiting, diarrhoea and fever, and 4 stopped because of drug-related events.
?How long is anidulafungin given for?
For candidaemia and other Candida infections, the label says to continue for at least 14 days after the last positive culture, after a loading dose on day 1. Esophageal candidiasis is treated for at least 14 days and for at least 7 days after symptoms resolve.
References
- [fda] US FDA, Drugs@FDA (openFDA): ERAXIS, NDA 021632 (February 17, 2006). Read October 3, 2026.
- [fda-pi] FDA. Eraxis (anidulafungin) US prescribing information (DailyMed set a88d9010-55fb-4a02-baff-042cd27688ea, effective August 19, 2025). Read October 3, 2026.
- [clinical-trial] Reboli AC, et al. "Anidulafungin versus fluconazole for invasive candidiasis." N Engl J Med, 2007;356(24):2472-82. PMID: 17568028.
- [clinical-trial] Krause DS, et al. "A randomized, double-blind trial of anidulafungin versus fluconazole for the treatment of esophageal candidiasis." Clin Infect Dis, 2004;39(6):770-5. PMID: 15472806.
- [clinical-trial] Roilides E, et al. "A Prospective, Open-label Study to Assess the Safety, Tolerability and Efficacy of Anidulafungin in the Treatment of Invasive Candidiasis in Children 2 to <18 Years of Age." Pediatr Infect Dis J, 2019;38(3):275-279. PMID: 30418357.
Sources & Citations
Studies were read from their PubMed records; regulatory sources are listed below, read October 3, 2026.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Consult a licensed healthcare provider before making health decisions.