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El grupo farmacológico de las equinocandinas estará enriquecido por la próxima incorporación de nuevos miembros. El primero en comercializarse será anidulafungina, fármaco que presenta algunas características farmacocinéticas que lo distinguen con claridad del único de los representantes de esta familia de antifúngicos que existía hasta el momento: caspofungina. Concretamente, este nuevo fármaco presenta un volumen de distribución mayor, una semivida de eliminación más elevada y, además, un sistema de eliminación, degradación espontánea, que evita su implicación en interacciones con otros fármacos y hace posible su uso sin ajuste de la dosis en pacientes con insuficiencia renal o hepática. Éstas son las mayores diferencias farmacológicas con caspofungina, ya que este último requiere ajuste de la dosis en pacientes con insuficiencia hepática y en los tratados con inductores de la actividad de las isoenzimas del CYP450 y en los pacientes obesos. Además, se recomienda monitorizar las concentraciones plasmáticas de los pacientes que precisan tratamiento con caspofungina y reciban al mismo tiempo ciclosporina A o tacrolimus. De acuerdo con la experiencia clínica acumulada puede afirmarse que hay pocas diferencias en el perfil de tolerabilidad entre ambos fármacos que, en cualquier caso, resulta excelente.
Palabras clave:
Equinocandinas
Farmacocinética
Farmacodinamia
Interacciones
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.
Key words:
Equinocandins
Pharmacokinetic
Pharmacodynamic
Drug interactions
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