Drug Facts
Composition & Profile
Identifiers & Packaging
16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied ERAXIS (anidulafungin) for Injection is supplied in a single-dose vial of sterile, lyophilized, preservative-free, white to off-white powder. ERAXIS (anidulafungin) is available in the following packaging configuration: Single-Dose Vial of ERAXIS 100 mg NDC 0049-2242-01 One - 100 mg vial 16.2 Storage ERAXIS vials ERAXIS (unreconstituted) vials should be stored in a refrigerator at 2°C – 8°C (36°F – 46°F). Do not freeze. Excursions for 96 hours up to 25°C (77°F) are permitted, and the vial can be returned to storage at 2°C – 8°C (36°F – 46°F). Reconstituted solution ERAXIS reconstituted solution can be stored at up to 25°C (77°F) for up to 24 hours [see Dosage and Administration (2.3) ] . Infusion Solution ERAXIS infusion solution can be stored at temperatures up to 25°C (77°F) for up to 48 hours. Do not freeze [see Dosage and Administration (2.4) ] .; PRINCIPAL DISPLAY PANEL - 100 mg Vial Label 1 Sterile Single-dose Vial Eraxis ® (anidulafungin) for Injection 100 mg/vial For Intravenous Infusion Only PREMIERProRx ® Distributed by: Roerig Division of Pfizer Inc. New York, NY 10001 Rx only PRINCIPAL DISPLAY PANEL - 100 mg Vial Label; PRINCIPAL DISPLAY PANEL - 100 mg Vial Carton NDC 0049-2242-01 Unit Pack Contains: 1 Sterile Single-dose Vial Eraxis ® 100 mg Eraxis ® (anidulafungin) for Injection 100 mg/vial For Intravenous Infusion Only Store Vial in Refrigerator at 2° C - 8° C (36° F - 46° F). Do Not Freeze. PREMIERProRx ® Distributed by: Roerig Division of Pfizer Inc. New York, NY 10001 Rx only PRINCIPAL DISPLAY PANEL - 100 mg Vial Carton
- 16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied ERAXIS (anidulafungin) for Injection is supplied in a single-dose vial of sterile, lyophilized, preservative-free, white to off-white powder. ERAXIS (anidulafungin) is available in the following packaging configuration: Single-Dose Vial of ERAXIS 100 mg NDC 0049-2242-01 One - 100 mg vial 16.2 Storage ERAXIS vials ERAXIS (unreconstituted) vials should be stored in a refrigerator at 2°C – 8°C (36°F – 46°F). Do not freeze. Excursions for 96 hours up to 25°C (77°F) are permitted, and the vial can be returned to storage at 2°C – 8°C (36°F – 46°F). Reconstituted solution ERAXIS reconstituted solution can be stored at up to 25°C (77°F) for up to 24 hours [see Dosage and Administration (2.3) ] . Infusion Solution ERAXIS infusion solution can be stored at temperatures up to 25°C (77°F) for up to 48 hours. Do not freeze [see Dosage and Administration (2.4) ] .
- PRINCIPAL DISPLAY PANEL - 100 mg Vial Label 1 Sterile Single-dose Vial Eraxis ® (anidulafungin) for Injection 100 mg/vial For Intravenous Infusion Only PREMIERProRx ® Distributed by: Roerig Division of Pfizer Inc. New York, NY 10001 Rx only PRINCIPAL DISPLAY PANEL - 100 mg Vial Label
- PRINCIPAL DISPLAY PANEL - 100 mg Vial Carton NDC 0049-2242-01 Unit Pack Contains: 1 Sterile Single-dose Vial Eraxis ® 100 mg Eraxis ® (anidulafungin) for Injection 100 mg/vial For Intravenous Infusion Only Store Vial in Refrigerator at 2° C - 8° C (36° F - 46° F). Do Not Freeze. PREMIERProRx ® Distributed by: Roerig Division of Pfizer Inc. New York, NY 10001 Rx only PRINCIPAL DISPLAY PANEL - 100 mg Vial Carton
Overview
ERAXIS for Injection is a sterile, lyophilized product for intravenous (IV) infusion that contains anidulafungin. ERAXIS (anidulafungin) is a semi-synthetic lipopeptide synthesized from a fermentation product of Aspergillus nidulans . Anidulafungin is an echinocandin, a class of antifungal drugs that inhibits the synthesis of 1,3-β-D-glucan, an essential component of fungal cell walls. ERAXIS (anidulafungin) is 1-[(4R,5R)-4,5-dihydroxy-N 2 -[[4"-(pentyloxy)[1,1':4',1"-terphenyl]-4-yl]carbonyl]-L-ornithine]echinocandin B. Anidulafungin is a white to off-white powder that is practically insoluble in water and slightly soluble in ethanol. In addition to the active ingredient, anidulafungin, ERAXIS for Injection contains the following inactive ingredients: 100 mg/vial – fructose (100 mg), mannitol (500 mg), polysorbate 80 (250 mg), tartaric acid (11.2 mg), and sodium hydroxide and/or hydrochloric acid for pH adjustment. The empirical formula of anidulafungin is C 58 H 73 N 7 O 17 and the formula weight is 1140.3. The structural formula is: Prior to administration, ERAXIS for Injection requires reconstitution with sterile Water for Injection and subsequent dilution with either 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP (normal saline). Chemical Structure
Indications & Usage
ERAXIS is an echinocandin antifungal indicated for the treatment of the following infections: • Candidemia and other forms of Candida infections (intra-abdominal abscess and peritonitis) in adults and pediatric patients (1 month of age and older) ( 1.1 ) • Esophageal candidiasis in adults ( 1.2 ) Limitations of use • ERAXIS has not been studied in adult and pediatric patients with endocarditis, osteomyelitis, and meningitis due to Candida or in sufficient numbers of neutropenic patients. The dosage of ERAXIS for the treatment of Candida dissemination into the CNS and the eye has not been established. ( 1.3 , 5.3 , 8.4 ) • ERAXIS is associated with high relapse rates in esophageal candidiasis. ( 1.3 , 14.2 ) 1.1 Candidemia and Other Forms of Candida Infections (Intra-abdominal Abscess and Peritonitis) ERAXIS is indicated for the treatment of candidemia and the following Candida infections: intra-abdominal abscess and peritonitis in adults and pediatric patients 1 month of age and older [see Clinical Studies (14.1) and Microbiology (12.4) ] . 1.2 Esophageal Candidiasis ERAXIS is indicated for the treatment of esophageal candidiasis in adults [see Indications and Usage (1.3) , Clinical Studies (14.2) ] . 1.3 Limitations of Use • ERAXIS has not been studied in adult and pediatric patients with endocarditis, osteomyelitis, and meningitis due to Candida , and has not been studied in sufficient numbers of neutropenic patients to determine efficacy in this group. The dosage of ERAXIS for the treatment of Candida dissemination into the CNS and the eye has not been established [see Warning and Precautions (5.3) , Use in Specific Populations (8.4) ] . • ERAXIS is associated with high relapse rates in esophageal candidiasis [see Clinical Studies (14.2) ] . 1.4 Usage Specimens for fungal culture and other relevant laboratory studies (including histopathology) should be obtained prior to therapy to isolate and identify causative organism(s). Therapy may be instituted before the results of the cultures and other laboratory studies are known. However, once these results become available, antifungal therapy should be adjusted accordingly.
Dosage & Administration
Adults Pediatric Patients 1 Month of Age and Older Candidemia and other forms of Candida infections 200 mg loading dose on Day 1, followed by 100 mg once daily maintenance dose thereafter for at least 14 days after the last positive culture ( 2.1 ) 3 mg/kg (not to exceed 200 mg) loading dose on Day 1, followed by 1.5 mg/kg (not to exceed 100 mg) once daily maintenance dose thereafter for at least 14 days after the last positive culture ( 2.2 ) Esophageal candidiasis 100 mg loading dose on Day 1, followed by 50 mg once daily maintenance dose thereafter for a minimum of 14 days and for at least 7 days following resolution of symptoms ( 2.1 ) Not Approved Rate of Infusion for Adults and Pediatric Patients The rate of infusion should not exceed 1.1 mg/minute [equivalent to 1.4 mL/minute or 84 mL/hour when reconstituted and diluted per instructions] ( 2.3 , 2.4 ) 2.1 Recommended Dosage in Adults Candidemia and other Candida infections (intra-abdominal abscess and peritonitis) The recommended dose is a single 200 mg loading dose of ERAXIS on Day 1, followed by a 100 mg once daily maintenance dose thereafter. Duration of treatment should be based on the patient's clinical response. In general, antifungal therapy should continue for at least 14 days after the last positive culture. Esophageal Candidiasis The recommended dose is a single 100 mg loading dose of ERAXIS on Day 1, followed by a 50 mg once daily maintenance dose thereafter. Patients should be treated for a minimum of 14 days and for at least 7 days following resolution of symptoms. Duration of treatment should be based on the patient's clinical response. Because of the risk of relapse of esophageal candidiasis in patients with HIV infection, suppressive antifungal therapy may be considered after a course of treatment. 2.2 Recommended Dosage in Pediatric Patients (1 Month of Age and Older) Candidemia and other Candida infections (intra-abdominal abscess and peritonitis) The recommended dose is a single loading dose of 3 mg/kg (not to exceed 200 mg) of ERAXIS on Day 1, followed by a once daily maintenance dose of 1.5 mg/kg (not to exceed 100 mg) of ERAXIS thereafter. Overall antifungal treatment should continue for at least 14 days after the last positive culture. 2.3 Preparation for Administration ERAXIS for Injection must be reconstituted with sterile Water for Injection and subsequently diluted only with 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP (normal saline), prior to administration. The compatibility of reconstituted ERAXIS with intravenous substances, additives, or medications other than 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP (normal saline) has not been established. Do NOT dilute with other solutions or co-infuse with other medications or electrolytes . The infusion solution must not be frozen. Reconstitution of the 100 mg/vial Aseptically reconstitute each 100 mg vial with 30 mL of sterile Water for Injection to provide a concentration of 3.33 mg/mL. Storage of the Reconstituted Solution ERAXIS reconstituted solution can be stored at 25°C (77°F) for up to 24 hours prior to dilution into the infusion solution. Chemical and physical in-use stability of the reconstituted solution has been demonstrated for 24 hours at 25°C (77°F). From a microbiological point of view, following good aseptic practices, the reconstituted solution can be utilized for up to 24 hours when stored at 25°C. 2.4 Dilution and Administration of the Infusion Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If particulate matter or discoloration is identified, discard the solution. Adult Patients Aseptically transfer the contents of the reconstituted vial(s) into the appropriately sized IV bag (or bottle) containing either 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP (normal saline). See Table 1 for the dilution to a concentration of 0.77 mg/mL for the final infusion solution and infusion instructions for each dose. The rate of infusion should not exceed 1.1 mg/minute (equivalent to 1.4 mL/minute or 84 mL/hour when reconstituted and diluted per instructions) [see Warnings and Precautions (5.2) ]. Table 1: Dilution Requirements for ERAXIS Administration Dose Number of Reconstituted Vials Required Total Reconstituted Volume Required Infusion Volume Either 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP (normal saline) Total Infusion Volume Infusion solution concentration is 0.77 mg/mL Rate of Infusion Minimum Duration of Infusion 50 mg 1–100 mg 15 mL 50 mL 65 mL 1.4 mL/min or 84 mL/ hour 45 min 100 mg 1–100 mg 30 mL 100 mL 130 mL 1.4 mL/min or 84 mL/ hour 90 min 200 mg 2–100 mg 60 mL 200 mL 260 mL 1.4 mL/min or 84 mL/ hour 180 min Pediatric Patients The volume of infusion solution required to deliver the dose is dependent on the weight of the child. The reconstituted solution must be further diluted to a concentration of 0.77 mg/mL for the final infusion solution. A programmable syringe or infusion pump is recommended. The rate of infusion should not exceed 1.1 mg/minute (equivalent to 1.4 mL/minute or 84 mL/hour when reconstituted and diluted per instructions) [see Warnings and Precautions (5.2) ] . Steps for the Preparation of Pediatric Doses below 50 mg 1. Calculate pediatric patient dose and aseptically reconstitute vial(s) required according to reconstitution instructions to provide a concentration of 3.33 mg/mL (if dose is 50 mg or above, see preparation instructions for Adult Patients above ) [see Dosage and Administration (2.2 , 2.3) ] . 2. Calculate the volume (mL) of reconstituted ERAXIS required: [ Volume of reconstituted ERAXIS (mL) = Dose of ERAXIS (mg) ÷ 3.33 mg/mL] 3. Calculate the total volume of the infusion solution (mL) that contains a final concentration of 0.77 mg/mL: [ Total volume of infusion solution (mL) = Dose of ERAXIS (mg) ÷ 0.77 mg/mL] 4. Calculate the volume of diluent [5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP (normal saline)] required to prepare the infusion solution: [ Volume of diluent (mL) = Total volume of final infusion solution (mL) – Volume of reconstituted ERAXIS (mL)] 5. Prepare the infusion solution by aseptically transferring the required volumes (mL) of the reconstituted ERAXIS and diluent [5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP (normal saline)] into an infusion syringe or IV infusion bag needed for administration. Storage of the Infusion Solution ERAXIS infusion solution can be stored at temperatures up to 25°C (77°F) for up to 48 hours. Do not freeze. Chemical and physical in-use stability of the infusion solution has been demonstrated for 48 hours at 25°C (77°F). From a microbiological point of view, following good aseptic practices, the infusion solution can be utilized for up to 48 hours from preparation when stored at 25°C.
Warnings & Precautions
• Hepatic Effects : Risk of abnormal liver tests, hepatitis, hepatic failure; monitor hepatic function during therapy. ( 5.1 , 13.2 ) • Hypersensitivity : Anaphylaxis, including shock has been reported. Risk of infusion-related adverse reactions, possibly histamine-mediated, including rash, urticaria, flushing, pruritus, bronchospasm, dyspnea, and hypotension; to reduce occurrence, do not exceed a rate of infusion of 1.1 mg/minute. ( 2.4 , 5.2 ) • Risk of Neonatal Toxicity Associated with Polysorbates : ERAXIS contains polysorbate 80, an inactive ingredient. Thrombocytopenia, renal dysfunction, hepatomegaly, cholestasis, ascites, hypotension and metabolic acidosis haves been reported in low-birth weight infants receiving high doses of polysorbate. ERAXIS is not approved in pediatric patients younger than 1 month of age. ( 5.3 , 8.4 ) • Hereditary Fructose Intolerance (HFI) : ERAXIS contains fructose. Risk of metabolic crisis with life-threatening hypoglycemia, hypophosphatemia, lactic acidosis, and hepatic failure. Obtain history of HFI symptoms in pediatric patients before ERAXIS administration. ( 5.4 , 8.4 ) 5.1 Hepatic Adverse Reactions Laboratory abnormalities in liver tests have been seen in healthy volunteers and pediatric patients treated with ERAXIS. In some patients with serious underlying medical conditions who were receiving multiple concomitant medications along with ERAXIS, clinically significant hepatic abnormalities have occurred. Isolated cases of significant hepatic dysfunction, hepatitis, or hepatic failure have been reported in patients; a causal relationship to ERAXIS has not been established [see Adverse Reactions (6.1) and Nonclinical Toxicology (13.2) ] . Patients who develop abnormal liver tests during ERAXIS therapy should be monitored for evidence of worsening hepatic tests and evaluated for risk/benefit of continuing ERAXIS therapy. 5.2 Anaphylactic and Hypersensitivity Reactions Anaphylactic reactions, including shock were reported with the use of ERAXIS. If these reactions occur, ERAXIS should be discontinued and appropriate treatment administered [see Adverse Reactions (6) ] . Infusion-related adverse reactions, possibly histamine-mediated, have been reported with ERAXIS, including rash, urticaria, flushing, pruritus, bronchospasm, dyspnea, and hypotension [see Adverse Reactions (6) ] . To reduce occurrence of these reactions, do not exceed a rate of ERAXIS infusion of 1.1 mg/minute [see Dosage and Administration (2.4) ] . 5.3 Risk of Neonatal Toxicity Associated with Polysorbates ERAXIS contains polysorbate 80, an inactive ingredient. Thrombocytopenia, renal dysfunction, hepatomegaly, cholestasis, ascites, hypotension, and metabolic acidosis have been reported in low-birth weight infants receiving high doses of polysorbate. Polysorbate toxicity has not been reported with ERAXIS. ERAXIS is not approved in pediatric patients younger than 1 month of age [see Indications and Usage (1.1 , 1.3) , Use in Specific Populations (8.4) ]. 5.4 Risk in Patients with Hereditary Fructose Intolerance (HFI) ERAXIS contains fructose, an inactive ingredient, and may precipitate a metabolic crisis that may include, but is not limited to life-threatening hypoglycemia, hypophosphatemia, lactic acidosis, and hepatic failure in patients with HFI. Obtain careful history of HFI symptoms (nausea, vomiting, abdominal pain) with fructose/sucrose exposure prior to ERAXIS administration because a diagnosis of HFI may not yet be established in pediatric patients [see Contraindications (4) and Use in Specific Populations (8.4) ] .
Contraindications
ERAXIS is contraindicated in: • Patients with known hypersensitivity to anidulafungin, any component of ERAXIS, or other echinocandins [see Warnings and Precautions (5.2) ] • Patients with known or suspected Hereditary Fructose Intolerance (HFI) [see Warnings and Precautions (5.4) ] • Known hypersensitivity to anidulafungin, any component of ERAXIS, or other echinocandins ( 4 , 5.2 ) • Known or suspected Hereditary Fructose Intolerance (HFI) ( 4 , 5.4 )
Adverse Reactions
The following most serious adverse reactions are described elsewhere in other labeling sections: • Hepatic Adverse Reactions [see Warnings and Precautions (5.1) ] • Anaphylactic and Hypersensitivity Reactions [see Warnings and Precautions (5.2) ] Adults • Candidemia and other forms of Candida infections: Most common adverse reactions (≥15%) are hypokalemia, nausea, diarrhea, vomiting, pyrexia, insomnia, hypotension. ( 6.1 ) • Esophageal candidiasis: Most common adverse reactions (≥5%) are diarrhea, pyrexia, anemia, headache, vomiting, nausea, dyspepsia, oral candidiasis, and hypokalemia. ( 6.1 ) Pediatric Patients (1 month and older) Candidemia and other forms of Candida infections: Most common adverse reactions (≥ 5%): diarrhea, vomiting, pyrexia, abdominal pain, anemia, thrombocytopenia, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased, hypoglycemia, epistaxis, and rash. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Pfizer Inc at 1-800-438-1985 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Clinical Trials Experience in Adults The safety of ERAXIS for Injection was assessed in 929 individuals, including 257 healthy subjects and 672 patients in clinical trials of candidemia, other forms of Candida infections, and esophageal candidiasis. A total of 633 patients received ERAXIS at daily doses of either 50 mg or 100 mg. A total of 481 patients received ERAXIS for ≥14 days. Candidemia/other Candida Infections Three trials (one comparative vs. fluconazole, two non-comparative) assessed the efficacy and safety of ERAXIS (100 mg) in patients with candidemia and other Candida infections. The data described below reflect exposure to ERAXIS and fluconazole in 127 and 118 patients, respectively, with candidemia and other forms of invasive candidiasis, in the randomized, comparative trial of the efficacy and safety of ERAXIS to that of fluconazole. In ERAXIS-treated patients, the age range was 16–89 years, the gender distribution was 51% male and 49% female, and the race distribution was 72% White, 18% Black/African American, 9% other races. Patients were randomized to receive once daily IV ERAXIS (200 mg loading dose followed by 100 mg maintenance dose) or IV fluconazole (800 mg loading dose followed by 400 mg maintenance dose). Treatment was administered for at least 14 and not more than 42 days. The number of patients with adverse reactions leading to discontinuation of study medication was 11.5% in the ERAXIS arm and 21.6% in the fluconazole arm. The most common adverse reactions leading to study drug discontinuation were multi-organ failure (2.3%) and systemic Candida infection (1.5%) in the ERAXIS arm. Table 2 presents adverse reactions that were reported in ≥5% of subjects receiving ERAXIS or fluconazole therapy in this trial. Table 2: Adverse Reactions Reported in ≥5% of Adult Patients Receiving ERAXIS or Fluconazole Therapy for Candidemia/other Candida Infections A patient who experienced multiple reactions within a Body System or preferred term was counted one time for that class, one time for the preferred term and one time for "subjects with at least one adverse reaction". , This trial was not designed to support comparative claims for ERAXIS for the adverse reactions reported in this table. Adverse Reaction ERAXIS 100 mg N=131 Fluconazole 400 mg N=125 N (%) N (%) Subjects with a least one adverse reaction 130 (99) 122 (98) Gastrointestinal disorders 81 (62) 72 (58) Nausea 32 (24) 15 (12) Diarrhea 24 (18) 23 (18) Vomiting 23 (18) 12 (10) Constipation 11 (8) 14 (11) Abdominal pain 8 (6) 16 (13) General disorders and administration site conditions 70 (53) 76 (61) Pyrexia 23 (18) 23 (18) Edema peripheral 14 (11) 16 (13) Chest pain 7 (5) 6 (5) Respiratory, thoracic, and mediastinal disorders 67 (51) 55 (44) Dyspnea 15 (12) 4 (3) Pleural effusion 13 (10) 11 (9) Cough 9 (7) 7 (6) Respiratory distress 8 (6) 2 (2) Investigations 66 (50) 46 (37) Blood alkaline phosphatase increased 15 (12) 14 (11) White blood cell increased 11 (8) 3 (2) Hepatic enzyme increased 7 (5) 14 (11) Blood creatinine increased 7 (5) 1 (1) Metabolism and nutrition disorders 61 (47) 61 (49) Hypokalemia 33 (25) 24 (19) Hypomagnesemia 15 (12) 14 (11) Hypoglycemia 9 (7) 10 (8) Hyperkalemia 8 (6) 14 (11) Hyperglycemia 8 (6) 8 (6) Dehydration 8 (6) 2 (2) Vascular disorders 50 (38) 41 (33) Hypotension 19 (15) 18 (14) Hypertension 15 (12) 5 (4) Deep vein thrombosis 13 (10) 9 (7) Psychiatric disorders 48 (37) 45 (36) Insomnia 20 (15) 12 (10) Confusional state 10 (8) 10 (8) Depression 8 (6) 5 (4) Blood and lymphatic system disorders 34 (26) 36 (29) Anemia 12 (9) 20 (16) Thrombocythemia 8 (6) 1 (1) Leukocytosis 7 (5) 6 (5) Skin and subcutaneous tissue disorders 30 (23) 32 (26) Decubitus ulcer 7 (5) 10 (8) Nervous system disorders 27 (21) 31 (25) Headache 11 (8) 10 (8) Musculoskeletal and connective tissue disorders 27 (21) 25 (20) Back pain 7 (5) 13 (10) Esophageal Candidiasis The data described below reflect exposure to ERAXIS and fluconazole in 300 and 301 patients, respectively, with esophageal candidiasis in a randomized trial comparing the efficacy and safety of ERAXIS to that of oral fluconazole. In ERAXIS-treated patients, the age range was 18–68 years, the gender distribution was 42% male and 58% female and the race distribution was 15% White, 49% Black/African American, 15% Asian, 0.3 % Hispanic, 21% other races. Patients were randomized to receive IV ERAXIS (100 mg on day 1, followed by 50 mg per day) or oral fluconazole (200 mg on day 1, followed by 100 mg per day) for 7 days beyond resolution of symptoms (range, 14–21 days). Twenty-eight (9%) patients in the ERAXIS arm and 36 (12%) patients in the fluconazole arm had adverse reactions related to study medication. The most common adverse reactions leading to study discontinuation were maculopapular rash (1 patient) for the ERAXIS arm. The most common adverse reactions leading to discontinuation were rash (1 patient) and increased AST (1 patient) for the fluconazole arm. Table 3 presents adverse reactions that were reported in ≥5% of subjects receiving ERAXIS therapy. Table 3: Adverse Reactions Reported in ≥5% of Adult Patients Receiving ERAXIS or Fluconazole Therapy for Esophageal Candidiasis A patient who experienced multiple reactions within a Body System or preferred term was counted one time for that class, one time for the preferred term and one time for "subjects with at least one adverse reaction". , This trial was not designed to support comparative claims for ERAXIS for the adverse reactions reported in this table. Adverse Reaction ERAXIS 50 mg N=300 Fluconazole 100 mg N=301 N (%) N (%) Subjects with a least one adverse reaction 239 (80) 227 (75) Infections and infestations 115 (38) 99 (33) Oral candidiasis 15 (5) 10 (3) Gastrointestinal disorders 106 (35) 113 (38) Diarrhea 27 (9) 26 (9) Vomiting 27 (7) 30 (10) Nausea 20 (7) 23 (8) Dyspepsia 20 (7) 21 (7) Blood and lymphatic system disorders 55 (18) 50 (17) Anemia 25 (8) 22 (7) Metabolism and nutrition disorders 50 (17) 46 (15) Hypokalemia 14 (5) 17 (6) General disorders and administration site condition 49 (16) 54 (18) Pyrexia 27 (9) 28 (9) Nervous system disorders 39 (13) 36 (12) Headache 25 (8) 20 (7) Less Common Adverse Reactions in Adult Patients with Candidemia/other Candida Infections and Esophageal Candidiasis The following selected adverse reactions occurred in <2% of patients: Blood and Lymphatic : coagulopathy, thrombocytopenia Cardiac : atrial fibrillation, bundle branch block (right), sinus arrhythmia, ventricular extrasystoles Eye : eye pain, vision blurred, visual disturbance General and Administration Site : infusion related reaction, peripheral edema, rigors Hepatobiliary : abnormal liver function tests, cholestasis, hepatic necrosis Infections : clostridial infection Investigations : amylase increased, bilirubin increased, CPK increased, electrocardiogram QT prolonged, gamma-glutamyl transferase increased, lipase increased, potassium decreased, prothrombin time prolonged, urea increased Nervous System : convulsion, dizziness Respiratory, Thoracic and Mediastinal : cough Skin and Subcutaneous Tissue : angioneurotic edema, erythema, pruritus, sweating increased, urticaria Vascular : flushing, hot flushes, thrombophlebitis superficial Clinical Trials Experience in Pediatric Patients with Candidemia/Invasive Candidiasis The safety of ERAXIS was investigated in 68 pediatric patients from 1 month to less than 18 years of age with candidemia/invasive candidiasis in a prospective, open-label, non-comparative pediatric trial [see Clinical Studies (14.1) ] . Overall, the safety profile of ERAXIS in the pediatric patients 1 month and older was similar to that of adults. Most Common Adverse Reactions The most common adverse reactions occurring in ≥5% of pediatric patients receiving ERAXIS therapy in the clinical trial are displayed by body system in Table 4. Table 4 Adverse Reactions Occurring in ≥5% of Pediatric Patients Receiving ERAXIS Therapy for Candidemia/other Candida Infections Reflects adverse reactions including those that started on or after first dose of anidulafungin through 6-week follow-up for patients who did not receive oral fluconazole, and those that started between first dose and last dose of anidulafungin for patients who received oral fluconazole. , A patient who experienced multiple reactions within a Body System or preferred term was counted one time for that class, one time for the preferred term and one time for "subjects with at least one adverse reaction". Adverse Reaction 1 month to <2 years N=19 2 to <5 years N=19 5 to <18 years N=30 Overall N=68 n (%) n (%) n (%) n (%) Subjects with a least one adverse reaction 17 (90) 14 (74) 24 (80) 55 (81) Blood and lymphatic system disorders 9 (47) 3 (16) 4 (13) 16 (24) Anemia 5 (26) 2 (11) 0 7 (10) Thrombocytopenia 2 (11) 1 (5) 1 (3) 4 (6) Gastrointestinal disorders 8 (42) 8 (42) 12 (40) 28 (41) Diarrhea 4 (21) 2 (11) 5 (17) 11 (16) Vomiting 4 (21) 5 (26) 2 (7) 11 (16) Abdominal pain Includes such terms as: abdominal pain and abdominal pain upper. 0 4 (21) 2 (7) 6 (9) General disorders and administration site condition 5 (26) 6 (32) 9 (30) 20 (29) Pyrexia 4 (21) 3 (16) 5 (17) 12 (18) Laboratory Investigations 4 (21) 4 (21) 8 (27) 16 (24) Alanine aminotransferase increased 2 (11) 2 (11) 2 (7) 6 (9) Aspartate aminotransferase increased 2 (11) 1 (5) 1 (3) 4 (6) Metabolism and nutrition disorders 3 (16) 4 (21) 6 (20) 13 (19) Hypoglycemia 1 (5) 2 (11) 1 (3) 4 (6) Respiratory, thoracic and mediastinal disorders 5 (26) 5 (26) 5 (17) 15 (22) Epistaxis 1 (5) 2 (11) 3 (10) 6 (9) Skin and subcutaneous tissue disorders 6 (32) 5 (26) 5 (17) 16 (24) Rash Includes such terms as: rash and rash generalized. 3 (16) 1 (5) 2 (7) 6 (9) Other adverse reactions were reported in 2 or more pediatric patients and in less than 5% of the 68 pediatric patients treated with ERAXIS in the clinical trial: Blood and Lymphatic System Disorders: pancytopenia, thrombocytosis, febrile neutropenia, leukopenia, neutropenia Eye Disorders: Periorbital edema Gastrointestinal Disorders: gastroesophageal reflux disease, abdominal distension, nausea, stomatitis, dry mouth General Disorders and Administrative Site Conditions: chest pain, edema peripheral Infections and Infestations: bacteremia, device related infection, gastroenteritis, lower respiratory tract infection, upper respiratory tract infection, urinary tract infection Laboratory Investigations: gamma-glutamyltransferase increased, transaminases increased Metabolism and Nutrition Disorders: hypocalcemia, hypokalemia, hyponatremia, hypoproteinemia Musculoskeletal and Connective Tissue Disorders: back pain, pain in extremity Nervous System Disorders: headache, tremor, seizure Psychiatric Disorders: agitation Respiratory, Thoracic and Mediastinal Disorders: hemoptysis Vascular Disorders: hypotension 6.2 Post-marketing Experience The following adverse reactions have been identified during post approval use of anidulafungin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Immune : Anaphylactic shock, anaphylactic reaction, bronchospasm [see Warnings and Precautions (5.2) ] .
Drug Interactions
7.1 Cyclosporine Administration of multiple doses of anidulafungin and cyclosporine to healthy subjects resulted in no significant alteration in the steady state pharmacokinetics of either drug. No dosage adjustment of cyclosporine or anidulafungin is needed when the two drugs are co-administered [see Clinical Pharmacology (12.3) ] . 7.2 Voriconazole Administration of multiple doses of anidulafungin and voriconazole to healthy subjects resulted in no significant alteration in the steady state pharmacokinetics of either drug. No dosage adjustment of voriconazole or anidulafungin is needed when the two drugs are co-administered [see Clinical Pharmacology (12.3) ] . 7.3 Tacrolimus Administration of multiple doses of anidulafungin and a single-dose of tacrolimus to healthy subjects resulted in no significant alteration in the steady state pharmacokinetics of either drug. No dosage adjustment of tacrolimus or anidulafungin is needed when the two drugs are co-administered [see Clinical Pharmacology (12.3) ] . 7.4 Rifampin Administration of multiple doses of anidulafungin and rifampin to patients resulted in no significant alteration in the steady state pharmacokinetics of anidulafungin. No dosage adjustment of anidulafungin is needed when it is co-administered with rifampin [see Clinical Pharmacology (12.3) ] . 7.5 Amphotericin B Liposome for Injection Administration of multiple doses of anidulafungin and liposomal amphotericin B to patients resulted in no significant alteration in the steady state pharmacokinetics of anidulafungin. No dosage adjustment of anidulafungin is needed when it is co-administered with liposomal amphotericin B [see Clinical Pharmacology (12.3) ] .
Storage & Handling
16.2 Storage ERAXIS vials ERAXIS (unreconstituted) vials should be stored in a refrigerator at 2°C – 8°C (36°F – 46°F). Do not freeze. Excursions for 96 hours up to 25°C (77°F) are permitted, and the vial can be returned to storage at 2°C – 8°C (36°F – 46°F). Reconstituted solution ERAXIS reconstituted solution can be stored at up to 25°C (77°F) for up to 24 hours [see Dosage and Administration (2.3) ] . Infusion Solution ERAXIS infusion solution can be stored at temperatures up to 25°C (77°F) for up to 48 hours. Do not freeze [see Dosage and Administration (2.4) ] .
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