Ecalta

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ANNEX I

SUMMARY OF PRODUCT CHARACTERISTICS



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1. NAME OF THE MEDICINAL PRODUCT

ECALTA 100 mg powder for concentrate for solution for infusion

2. QUALITATIVE AND QUANTITATIVE COMPOSITION

Each vial contains 100 mg anidulafungin.
The reconstituted solution contains 3.33 mg/mL anidulafungin and the diluted solution contains 
0.77 mg/mL anidulafungin.

Excipient with known effect: Fructose 102.5 mg per vial

For the full list of excipients, see section 6.1.

3. PHARMACEUTICAL FORM

Powder for concentrate for solution for infusion. 
White to off-white solid. 
The reconstituted solution has a pH of 3.5 to 5.5. 

4. CLINICAL PARTICULARS

4.1 Therapeutic indications

Treatment of invasive candidiasis in adults and paediatric patients aged 1 month to < 18 years (see 
sections 4.4 and 5.1).

4.2 Posology and method of administration

Treatment with ECALTA should be initiated by a physician experienced in the management of 
invasive fungal infections.

Posology

Specimens for fungal culture should be obtained prior to therapy. Therapy may be initiated before 
culture results are known and can be adjusted accordingly once they are available.

Adult population (dosing and treatment duration)
A single 200 mg loading dose should be administered on Day 1, followed by 100 mg daily 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.

There are insufficient data to support the 100 mg dose for longer than 35 days of treatment.

Patients with renal and hepatic impairment
No dosing adjustments are required for patients with mild, moderate, or severe hepatic impairment. No 
dosing adjustments are required for patients with any degree of renal insufficiency, including those on 
dialysis. ECALTA can be given without regard to the timing of haemodialysis (see section 5.2).

Other special populations
No dosing adjustments are required for adult patients based on gender, weight, ethnicity, HIV 
positivity, or elderly (see section 5.2).



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Paediatric population (1 month to < 18 years) (dosing and treatment duration)
A single loading dose of 3.0 mg/kg (not to exceed 200 mg) should be administered on Day 1 followed 
by a daily maintenance dose of 1.5 mg/kg (not to exceed 100 mg) 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.

The safety and efficacy of ECALTA have not been established in neonates (< 1 month old) (see 
section 4.4). 

Method of administration

For intravenous use only.

ECALTA should be reconstituted with water for injection to a concentration of 3.33 mg/mL and 
subsequently diluted to a concentration of 0.77 mg/mL for the final infusion solution. For a paediatric 
patient, the volume of infusion solution required to deliver the dose will vary depending on the weight 
of the child. For instructions on reconstitution of the medicinal product before administration (see 
section 6.6).

It is recommended that ECALTA be administered at a rate of infusion that does not exceed
1.1 mg/min (equivalent to 1.4 mL/min when reconstituted and diluted per instructions). Infusion 
associated reactions are infrequent when the rate of anidulafungin infusion does not exceed 
1.1 mg/min (see section 4.4).

ECALTA must not be administered as a bolus injection.

4.3 Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. 

Hypersensitivity to other medicinal products of the echinocandin class.

4.4 Special warnings and precautions for use

ECALTA has not been studied in patients with Candida endocarditis, osteomyelitis or meningitis.

The efficacy of ECALTA has only been evaluated in a limited number of neutropenic patients (see 
section 5.1).

Paediatric population

Treatment with ECALTA in neonates (< 1 month old) is not recommended. Treating neonates requires 
consideration for coverage of disseminated candidiasis including central nervous system (CNS); 
nonclinical infection models indicate that higher doses of anidulafungin are needed to achieve 
adequate CNS penetration (see section 5.3), resulting in higher doses of polysorbate 80, a formulation 
excipient. High doses of polysorbates have been associated with potentially life-threatening toxicities 
in neonates as reported in the literature.

There is no clinical data to support the efficacy and safety of higher doses of anidulafungin than 
recommended in 4.2.

Hepatic effects

Increased levels of hepatic enzymes have been seen in healthy subjects and patients treated with 
anidulafungin. In some patients with serious underlying medical conditions who were receiving 



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multiple concomitant medicines along with anidulafungin, clinically significant hepatic abnormalities 
have occurred. Cases of significant hepatic dysfunction, hepatitis, and hepatic failure were uncommon 
in clinical trials. Patients with increased hepatic enzymes during anidulafungin therapy should be 
monitored for evidence of worsening hepatic function and evaluated for risk/benefit of continuing 
anidulafungin therapy.

Anaphylactic reactions

Anaphylactic reactions, including shock, were reported with the use of anidulafungin. If these 
reactions occur, anidulafungin should be discontinued and appropriate treatment administered.

Infusion-related reactions

Infusion-related adverse events have been reported with anidulafungin, including rash, urticaria, 
flushing, pruritus, dyspnoea, bronchospasm and hypotension. Infusion-related adverse events are 
infrequent when the rate of anidulafungin infusion does not exceed 1.1 mg/min (see section 4.8).

Exacerbation of infusion-related reactions by co-administration of anaesthetics has been seen in a non-
clinical (rat) study (see section 5.3). The clinical relevance of this is unknown. Nevertheless, care 
should be taken when co-administering anidulafungin and anaesthetic agents.

Fructose content

Patients with hereditary fructose intolerance (HFI) should not be given this medicine unless strictly 
necessary.

Babies and young children (below 2 years of age) may not yet be diagnosed with HFI. Medicines 
(containing fructose) given intravenously may be life-threatening and should not be administered in 
this population unless there is an overwhelming clinical need and no alternatives are available. A
detailed history with regard to HFI symptoms has to be taken of each patient prior to being given this 
medicinal product.

4.5 Interaction with other medicinal products and other forms of interaction

Anidulafungin is not a clinically relevant substrate, inducer, or inhibitor of cytochrome P450 
isoenzymes (1A2, 2B6, 2C8, 2C9, 2C19, 2D6, 3A). Of note, in vitro studies do not fully exclude 
possible in vivo interactions. 

Drug interaction studies were performed with anidulafungin and other medicinal products likely to be 
co-administered. No dosage adjustment of either medicinal product is recommended when 
anidulafungin is co-administered with ciclosporin, voriconazole or tacrolimus, and no dosage 
adjustment for anidulafungin is recommended when co-administered with amphotericin B or 
rifampicin.

Paediatric population

Interaction studies have only been performed in adults.

4.6 Fertility, pregnancy and lactation

Pregnancy

There are no data from the use of anidulafungin in pregnant women. Studies in animals have shown 
reproductive toxicity (see section 5.3).

ECALTA is not recommended during pregnancy unless the benefit to the mother clearly outweighs the 
potential risk to the foetus.



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Breast-feeding

It is unknown whether anidulafungin is excreted in human milk. Available 
pharmacodynamic/toxicological data in animals have shown excretion of anidulafungin in milk.

A risk to the suckling child cannot be excluded. A decision must be made whether to discontinue 
breast-feeding or to discontinue/abstain from ECALTA therapy taking into account the benefit of 
breast-feeding for the child and the benefit of therapy for the woman.

Fertility

For anidulafungin, there were no effects on fertility in studies conducted in male and female rats (see 
section 5.3).

4.7 Effects on ability to drive and use machines

Not relevant.

4.8 Undesirable effects

Summary of the safety profile

Infusion-related adverse reactions have been reported with anidulafungin in clinical studies, including
rash, pruritus, dyspnoea, bronchospasm, hypotension (common events), flushing, hot flush, and 
urticaria (uncommon events), summarized in Table 1 (see section 4.4).

Tabulated list of adverse reactions

The following table includes, the all-causality adverse reactions (MedDRA terms) from 840 subjects 
receiving 100 mg anidulafungin with frequency corresponding to very common (≥1/10), common 
(1/100 to <1/10), uncommon (1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare 
(<1/10,000) and from spontaneous reports with frequency not known (cannot be estimated from the 
available data). Within each frequency grouping, undesirable effects are presented in order of 
decreasing seriousness.

Table 1. Table of Adverse Reactions

System Organ 
Class

Very 
Common

≥ 1/10

Common
≥ 1/100

to 
< 1/10

Uncommon
≥ 1/1000

to 
<1/100

Rare
≥

1/10,000 
to 

<1/1,000

Very 
Rare

< 
1/10,000

Not Known

Blood and 
Lymphatic System 
Disorders

Coagulopathy

Immune System 
Disorders

Anaphylacti
c shock,
anaphylactic 
reaction*

Metabolism and 
Nutrition Disorders

Hypokalaemia Hyperglycaemia

Nervous System 
Disorders 

Convulsion,
headache

Vascular Disorders Hypotension,
hypertension

Flushing,
hot flush



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Table 1. Table of Adverse Reactions

System Organ 
Class

Very 
Common

≥ 1/10

Common
≥ 1/100

to 
< 1/10

Uncommon
≥ 1/1000

to 
<1/100

Rare
≥

1/10,000 
to 

<1/1,000

Very 
Rare

< 
1/10,000

Not Known

Respiratory, 
Thoracic and 
Mediastinal 
Disorders 

Bronchospasm,
Dyspnoea

Gastrointestinal 
Disorders 

Diarrhoea,
Nausea

Vomiting Abdominal 
pain upper

Hepatobiliary 
Disorders 

Alanine 
aminotransferase 
increased,
blood alkaline 
phosphatase 
increased,
aspartate 
aminotransferase 
increased, blood 
bilirubin 
increased,
cholestasis

Gamma-
glutamyltrans
ferase 
increased

Skin and 
Subcutaneous 
Tissue Disorders 

Rash,
pruritus

Urticaria

Renal and Urinary 
Disorders 

Blood creatinine 
increased

General Disorders 
and Administration 
Site Conditions 

Infusion site 
pain

* See section 4.4.

Paediatric population

The safety of anidulafungin was investigated in 68 paediatric patients (1 month to < 18 years) with 
ICC in a prospective, open-label, non-comparative paediatric study (see section 5.1). The frequencies 
of certain hepatobiliary adverse events, including alanine aminotransferase (ALT) increased and 
aspartate aminotransferase (AST) increased appeared at a higher frequency (7-10%) in these paediatric 
patients than has been observed in adults (2%). Although chance or differences in underlying disease 
severity may have contributed, it cannot be excluded that hepatobiliary adverse reactions occur more 
frequently in paediatric patients compared to adults.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 
professionals are asked to report any suspected adverse reactions via the national reporting system 
listed in Appendix V.

4.9 Overdose

As with any overdose, general supportive measures should be utilised as necessary. In case of 
overdose, adverse reactions may occur as mentioned in section 4.8.

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


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During clinical trials, a single 400 mg dose of anidulafungin was inadvertently administered as a 
loading dose. No clinical adverse reactions were reported. No dose limiting toxicity was observed in a 
study of 10 healthy subjects administered a loading dose of 260 mg followed by 130 mg daily; 3 of the 
10 subjects experienced transient, asymptomatic transaminase elevations ( 3 x Upper Limit of 
Normal (ULN)).

During a paediatric clinical trial, one subject received two doses of anidulafungin that were 143% of 
the expected dose. No clinical adverse reactions were reported.

ECALTA is not dialysable.

5. PHARMACOLOGICAL PROPERTIES

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: – Antimycotics for systemic use, other antimycotics for systemic use.
ATC code: JO2AX06

Mechanism of action

Anidulafungin is a semi-synthetic echinocandin, a lipopeptide synthesised from a fermentation product 
of Aspergillus nidulans.

Anidulafungin selectively inhibits 1,3-β-D glucan synthase, an enzyme present in fungal, but not 
mammalian cells. This results in inhibition of the formation of 1,3--D-glucan, an essential component 
of the fungal cell wall. Anidulafungin has shown fungicidal activity against Candida species and 
activity against regions of active cell growth of the hyphae of Aspergillus fumigatus.

Activity in vitro

Anidulafungin exhibited in-vitro activity against C. albicans, C. glabrata, C. parapsilosis, C. krusei 
and C. tropicalis. For the clinical relevance of these findings see “Clinical efficacy and safety.” 

Isolates with mutations in the hot spot regions of the target gene have been associated with clinical 
failures or breakthrough infections. Most clinical cases involve caspofungin treatment. However, in 
animal experiments these mutations confer cross resistance to all three echinocandins and therefore 
such isolates are classified as echinocandin resistant until further clinical experience are obtained 
concerning anidulafungin.

The in vitro activity of anidulafungin against Candida species is not uniform. Specifically, for C. 
parapsilosis, the MICs of anidulafungin are higher than are those of other Candida species. A 
standardized technique for testing the susceptibility of Candida species to anidulafungin as well as the 
respective interpretative breakpoints has been established by European Committee on Antimicrobial 
Susceptibility Testing (EUCAST).



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Table 2. EUCAST Breakpoints
Candida Species MIC breakpoint (mg/L)

≤S (Susceptible) >R (Resistant)
Candida albicans 0.03 0.03
Candida glabrata 0.06 0.06
Candida tropicalis 0.06 0.06
Candida krusei 0.06 0.06
Candida parapsilosis 4 4
Other Candida spp.1 Insufficient evidence
1 Non-species related breakpoints have been determined mainly on the 
basis of PK/PD data and are independent of MIC distributions of specific 
Candida species. They are for use only for organisms that do not have 
specific breakpoints

Activity in vivo

Parenterally administered anidulafungin was effective against Candida species in immunocompetent 
and immunocompromised mouse and rabbit models. Anidulafungin treatment prolonged survival and 
also reduced the organ burden of Candida species, when determined at intervals from 24 to 96 hours 
after the last treatment.

Experimental infections included disseminated C. albicans infection in neutropenic rabbits, 
oesophageal/oropharyngeal infection of neutropenic rabbits with fluconazole-resistant C. albicans and 
disseminated infection of neutropenic mice with fluconazole-resistant C. glabrata.

Clinical efficacy and safety

Candidaemia and other forms of Invasive Candidiasis
The safety and efficacy of anidulafungin were evaluated in a pivotal Phase 3, randomised, double-
blind, multicentre, multinational study of primarily non-neutropenic patients with candidaemia and a 
limited number of patients with deep tissue Candida infections or with abscess-forming disease. 
Patients with Candida endocarditis, osteomyelitis or meningitis, or those with infection due to 
C. krusei, were specifically excluded from the study. Patients were randomised to receive either 
anidulafungin (200 mg intravenous loading dose followed by 100 mg intravenous daily) or 
fluconazole (800 mg intravenous loading dose followed by 400 mg intravenous daily), and were 
stratified by APACHE II score (≤20 and >20) and the presence or absence of neutropenia. Treatment 
was administered for at least 14 and not more than 42 days. Patients in both study arms were permitted 
to switch to oral fluconazole after at least 10 days of intravenous therapy, provided that they were able 
to tolerate oral medicinal products and were afebrile for at least 24 hours, and that the most recent 
blood cultures were negative for Candida species.

Patients who received at least one dose of study medicinal products and who had a positive culture for 
Candida species from a normally sterile site before study entry were included in the modified intent-
to-treat (MITT) population. In the primary efficacy analysis, global response in the MITT populations 
at the end of intravenous therapy, anidulafungin was compared to fluconazole in a pre-specified two-
step statistical comparison (non-inferiority followed by superiority). A successful global response 
required clinical improvement and microbiological eradication. Patients were followed for six weeks 
beyond the end of all therapy.

Two hundred and fifty-six patients, ranging from 16 to 91 years in age, were randomised to treatment 
and received at least one dose of study medication. The most frequent species isolated at baseline were 
C. albicans (63.8% anidulafungin, 59.3% fluconazole), followed by C. glabrata (15.7%, 25.4%), 
C. parapsilosis (10.2%, 13.6%) and C. tropicalis (11.8%, 9.3%) - with 20, 13 and 15 isolates of the 
last 3 species, respectively, in the anidulafungin group. The majority of patients had Apache II scores 
≤ 20 and very few were neutropenic.



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Efficacy data, both overall and by various subgroups, are presented below in Table 3.

Table 3. Global success in the MITT population: primary and secondary endpoints
Anidulafungin Fluconazole Between group 

difference a

(95% CI)
End of IV Therapy (1º endpoint) 96/127 (75.6%) 71/118 (60.2%) 15.42 (3.9, 27.0)
  Candidaemia only 88/116 (75.9%) 63/103 (61.2%) 14.7 (2.5, 26.9)
  Other sterile sitesb 8/11 (72.7%) 8/15 (53.3%) -
      Peritoneal fluid/IAc abscess 6/8 5/8
       Other 2/3 3/7

  C. albicansd 60/74 (81.1%) 38/61 (62.3%) -
  Non-albicans speciesd 32/45 (71.1%) 27/45 (60.0%) -

  Apache II score ≤ 20 82/101 (81.2%) 60/98 (61.2%) -

  Apache II score  20 14/26 (53.8%) 11/20 (55.0%) -

  Non-neutropenic (ANC, cells/mm3 
500)

94/124 (75.8%) 69/114 (60.5%) -

  Neutropenic (ANC, cells/mm3 ≤ 500) 2/3 2/4 -
At Other Endpoints
  End of All Therapy 94/127 (74.0%) 67/118 (56.8%) 17.24 (2.9, 31.6)e

  2 Week Follow-up 82/127 (64.6%) 58/118 (49.2%) 15.41 (0.4, 30.4)e

  6 Week Follow-up 71/127 (55.9%) 52/118 (44.1%) 11.84 (-3.4, 27.0)e
a Calculated as anidulafungin minus fluconazole
b With or without concurrent candidaemia
c Intra-abdominal
d Data presented for patients with a single baseline pathogen.
e 98.3% confidence intervals, adjusted post hoc for multiple comparisons of secondary time points.

Mortality rates in both the anidulafungin and fluconazole arms are presented below in Table 4:

Table 4. Mortality
Anidulafungin Fluconazole

Overall study mortality 29/127 (22.8%) 37/118 (31.4%)
Mortality during study therapy 10/127 (7.9%) 17/118 (14.4%)
Mortality attributed to Candida
infection

2/127 (1.6%) 5/118 (4.2%)

Additional Data in Neutropenic Patients 

The efficacy of anidulafungin (200 mg intravenous loading dose followed by 100 mg intravenous 
daily) in adult neutropenic patients (defined as absolute neutrophil count ≤ 500 cells/mm3, WBC ≤ 500 
cells/mm3 or classified by the investigator as neutropenic at baseline) with microbiologically 
confirmed invasive candidiasis was assessed in an analysis of pooled data from 5 prospective studies 
(1 comparative versus caspofungin and 4 open-label, non-comparative). Patients were treated for at 
least 14 days. In clinically stable patients, a switch to oral azole therapy was permitted after at least 5 
to 10 days of treatment with anidulafungin. A total of 46 patients were included in the analysis. The 
majority of patients had candidaemia only (84.8%; 39/46). The most common pathogens isolated at 
baseline were C. tropicalis (34.8%; 16/46), C. krusei (19.6%; 9/46), C. parapsilosis (17.4%; 8/46), C.
albicans (15.2%; 7/46), and C. glabrata (15.2%; 7/46). The successful global response rate at End of 
Intravenous Treatment (primary endpoint) was 26/46 (56.5%) and End of All Treatment was 24/46 
(52.2%). All-cause mortality up to the end of the study (6 Week Follow-up Visit) was 21/46 (45.7%).



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The efficacy of anidulafungin in adult neutropenic patients (defined as absolute neutrophil count ≤ 
500 cells/mm3 at baseline) with invasive candidiasis was assessed in a prospective, double-blind, 
randomized, controlled trial. Eligible patients received either anidulafungin (200 mg intravenous 
loading dose followed by 100 mg intravenous daily) or caspofungin (70 mg intravenous loading dose 
followed by 50 mg intravenous daily) (2:1 randomization). Patients were treated for at least 14 days. 
In clinically stable patients, a switch to oral azole therapy was permitted after at least 10 days of study 
treatment. A total of 14 neutropenic patients with microbiologically confirmed invasive candidiasis 
(MITT population) were enrolled in the study (11 anidulafungin; 3 caspofungin). The majority of 
patients had candidaemia only. The most common pathogens isolated at baseline were C. tropicalis 
(4 anidulafungin, 0 caspofungin), C. parapsilosis (2 anidulafungin, 1 caspofungin), C. krusei
(2 anidulafungin, 1 caspofungin), and C. ciferrii (2 anidulafungin, 0 caspofungin). The successful 
global response rate at the End of Intravenous Treatment (primary endpoint) was 8/11 (72.7%) for 
anidulafungin and 3/3 (100.0%) for caspofungin (difference -27.3, 95% CI -80.9, 40.3); the successful 
global response rate at the End of All Treatment was 8/11 (72.7%) for anidulafungin and 3/3 (100.0%) 
for caspofungin (difference -27.3, 95% CI -80.9, 40.3). All-cause mortality up to the 6 Week Follow-
Up visit for anidulafungin (MITT population) was 4/11 (36.4%) and 2/3 (66.7%) for caspofungin.

Patients with microbiologically confirmed invasive candidiasis (MITT population) and neutropenia 
were identified in an analysis of pooled data from 4 similarly designed prospective, open-label, non-
comparative studies. The efficacy of anidulafungin (200 mg intravenous loading dose followed by 
100 mg intravenous daily) was assessed in 35 adult neutropenic patients defined as absolute neutrophil 
count ≤ 500 cells/mm3 or WBC ≤ 500 cells/mm3 in 22 patients or classified by the investigator as 
neutropenic at baseline in 13 patients. All patients were treated for at least 14 days. In clinically stable 
patients, a switch to oral azole therapy was permitted after at least 5 to 10 days of treatment with 
anidulafungin. The majority of patients had candidaemia only (85.7%). The most common pathogens 
isolated at baseline were C. tropicalis (12 patients), C. albicans (7 patients), C. glabrata (7 patients), 
C. krusei (7 patients), and C. parapsilosis (6 patients). The successful global response rate at the End 
of Intravenous Treatment (primary endpoint) was 18/35 (51.4%) and 16/35 (45.7%) at the End of All 
Treatment. All-cause mortality by Day 28 was 10/35 (28.6%). The successful global response rate at
End of Intravenous Treatment and End of All Treatment were both 7/13 (53.8%) in the 13 patients 
with neutropenia assessed by investigators at baseline.

Additional Data in Patients with Deep Tissue Infections

The efficacy of anidulafungin (200 mg intravenous loading dose followed by 100 mg intravenous 
daily) in adult patients with microbiologically confirmed deep tissue candidiasis was assessed in an 
analysis of pooled data from 5 prospective studies (1 comparative and 4 open-label). Patients were
treated for at least 14 days. In the 4 open-label studies, a switch to oral azole therapy was permitted 
after at least 5 to 10 days of treatment with anidulafungin. A total of 129 patients were included in the 
analysis. Twenty one (16.3%) had concomitant candidaemia. The mean APACHE II score was 14.9 
(range, 2 – 44). The most common sites of infection included the peritoneal cavity (54.3%; 70 of 129), 
hepatobiliary tract (7.0%; 9 of 129), pleural cavity (5.4%; 7 of 129) and kidney (3.1%; 4 of 129). The 
most common pathogens isolated from a deep tissue site at baseline were C. albicans (64.3%; 83 of 
129), C. glabrata (31.0%; 40 of 129), C. tropicalis (11.6%; 15 of 129), and C. krusei (5.4%; 7 of 
129). The successful global response rate at the end of intravenous treatment (primary endpoint) and 
end of all treatment and all-cause mortality up to the 6 week follow-up visit is shown in Table 5.



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Table 5.  Rate of Successful Global Responsea and All-Cause Mortality in Patients with Deep 
Tissue Candidiasis – Pooled Analysis

MITT Population
n/N (%)

Global Response of Success at EOIVTb

     Overall 102/129 (79.1)
     Peritoneal cavity 51/70 (72.9)
     Hepatobiliary tract 7/9 (77.8)
     Pleural cavity 6/7 (85.7)
     Kidney 3/4 (75.0)
Global Response of Success at EOTb 94/129 (72.9)
All-Cause Mortality 40/129 (31.0)
a A successful global response was defined as both clinical and microbiologic success
b EOIVT, End of Intravenous Treatment; EOT, End of All Treatment

Paediatric population

A prospective, open-label, non-comparative, multi-national study assessed the safety and efficacy of 
anidulafungin in 68 paediatric patients aged 1 month to < 18 years with invasive candidiasis including 
candidaemia (ICC). Patients were stratified by age (1 month to < 2 years, 2 to < 5 years, and 5 to
< 18 years) and received once daily intravenous anidulafungin (3.0 mg/kg loading dose on Day 1, and 
1.5 mg/kg daily maintenance dose thereafter) for up to 35 days followed by an optional switch to oral 
fluconazole (6-12 mg/kg/day, maximum 800 mg/day). Patients were followed at 2 and 6 weeks after 
EOT. 

Among 68 patients who received anidulafungin, 64 had microbiologically confirmed Candida
infection and were evaluated for efficacy in the modified intent-to-treat (MITT) population. Overall, 
61 patients (92.2%) had Candida isolated from blood only. The most commonly isolated pathogens 
were Candida albicans (25 [39.1%] patients), followed by Candida parapsilosis (17 [26.6%] patients), 
and Candida tropicalis (9 [14.1%] patients). A successful global response was defined as having both 
a clinical response of success (cure or improvement) and a microbiological response of success 
(eradication or presumed eradication). The overall rates of successful global response in the MITT 
population are presented in Table 6.

Table 6. Summary of Successful Global Response by Age Group, MITT Population
Successful Global Response, n (%)

Timepoint Global 
Response

1 month to < 2 years
(N=16)

n (n/N, %)

2 to < 5 years
(N=18)

n (n/N, %)

5 to < 18 years
(N=30)

n (n/N, %)

Overall
(N=64)

n (n/N, %)
EOIVT Success 11 (68.8) 14 (77.8) 20 (66.7) 45 (70.3)

95% CI (41.3, 89.0) (52.4, 93.6) (47.2, 82.7) (57.6, 81.1)
EOT Success 11 (68.8) 14 (77.8) 21 (70.0) 46 (71.9)

95% CI (41.3, 89.0) (52.4, 93.6) (50.6, 85.3) (59.2, 82.4)
2-week FU Success 11 (68.8) 13 (72.2) 22 (73.3) 46 (71.9)

95% CI (41.3, 89.0) (46.5, 90.3) (54.1, 87.7) (59.2, 82.4)
6-week FU Success 11 (68.8) 12 (66.7) 20 (66.7) 43 (67.2)

95% CI (41.3, 89.0) (41.0, 86.7) (47.2, 82.7) (54.3, 78.4)
95% CI = exact 95% confidence interval for binomial proportions using Clopper-Pearson method; 
EOIVT = End of Intravenous Treatment; EOT = End of All Treatment; FU = follow-up; MITT = 
modified intent-to-treat; N = number of subjects in the population; n = number of subjects with
responses



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5.2 Pharmacokinetic properties

General pharmacokinetic characteristics 

The pharmacokinetics of anidulafungin have been characterised in healthy subjects, special 
populations and patients. A low intersubject variability in systemic exposure (coefficient of variation 
~25%) was observed. The steady state was achieved on the first day after a loading dose (twice the 
daily maintenance dose).

Distribution

The pharmacokinetics of anidulafungin are characterised by a rapid distribution half-life (0.5-1 hour) 
and a volume of distribution, 30-50 l, which is similar to total body fluid volume. Anidulafungin is 
extensively bound (>99%) to human plasma proteins. No specific tissue distribution studies of 
anidulafungin have been done in humans. Therefore, no information is available about the penetration 
of anidulafungin into the cerebrospinal fluid (CSF) and/or across the blood-brain barrier.  

Biotransformation 

Hepatic metabolism of anidulafungin has not been observed. Anidulafungin is not a clinically relevant 
substrate, inducer, or inhibitor of cytochrome P450 isoenzymes. It is unlikely that anidulafungin will 
have clinically relevant effects on the metabolism of drugs metabolised by cytochrome P450 
isoenzymes.

Anidulafungin undergoes slow chemical degradation at physiologic temperature and pH to a ring-
opened peptide that lacks antifungal activity. The in vitro degradation half-life of anidulafungin under 
physiologic conditions is approximately 24 hours. In vivo, the ring-opened product is subsequently
converted to peptidic degradants and eliminated mainly through biliary excretion.

Elimination

The clearance of anidulafungin is about 1 l/h. Anidulafungin has a predominant elimination half-life of 
approximately 24 hours that characterizes the majority of the plasma concentration-time profile, and a 
terminal half-life of 40-50 hours that characterises the terminal elimination phase of the profile.

In a single-dose clinical study, radiolabeled (14C) anidulafungin (~88 mg) was administered to healthy 
subjects. Approximately 30% of the administered radioactive dose was eliminated in the faeces over 9 
days, of which less than 10% was intact drug. Less than 1% of the administered radioactive dose was 
excreted in the urine, indicating negligible renal clearance. Anidulafungin concentrations fell below 
the lower limits of quantitation 6 days post-dose. Negligible amounts of drug-derived radioactivity 
were recovered in blood, urine, and faeces 8 weeks post-dose.

Linearity

Anidulafungin displays linear pharmacokinetics across a wide range of once daily doses (15-130 mg).

Special populations

Patients with fungal infections  
The pharmacokinetics of anidulafungin in patients with fungal infections are similar to those 
observed in healthy subjects based on population pharmacokinetic analyses. With the 200/100 mg 
daily dose regimen at an infusion rate of 1.1 mg/min, the steady state Cmax and trough 
concentrations (Cmin) could reach approximately 7 and 3 mg/l, respectively, with an average 
steady state AUC of approximately 110 mgh/l. 



13

Weight
Although weight was identified as a source of variability in clearance in the population 
pharmacokinetic analysis, weight has little clinical relevance on the pharmacokinetics of 
anidulafungin.

Gender
Plasma concentrations of anidulafungin in healthy men and women were similar. In multiple-dose 
patient studies, drug clearance was slightly faster (approximately 22%) in men.  

Elderly
The population pharmacokinetic analysis showed that median clearance differed slightly between the 
elderly group (patients ≥ 65, median CL = 1.07 l/h) and the non-elderly group (patients < 65, median 
CL = 1.22 l/h), however the range of clearance was similar.

Ethnicity
Anidulafungin pharmacokinetics were similar among Caucasians, Blacks, Asians, and Hispanics.  

HIV positivity
Dosage adjustments are not required based on HIV positivity, irrespective of concomitant anti-
retroviral therapy.

Hepatic insufficiency 
Anidulafungin is not hepatically metabolised. Anidulafungin pharmacokinetics were examined in 
subjects with Child-Pugh class A, B or C hepatic insufficiency. Anidulafungin concentrations were not 
increased in subjects with any degree of hepatic insufficiency. Although a slight decrease in AUC was 
observed in patients with Child-Pugh C hepatic insufficiency, the decrease was within the range of 
population estimates noted for healthy subjects.  

Renal insufficiency
Anidulafungin has negligible renal clearance (<1%). In a clinical study of subjects with mild, 
moderate, severe or end stage (dialysis-dependent) renal insufficiency, anidulafungin 
pharmacokinetics were similar to those observed in subjects with normal renal function. 
Anidulafungin is not dialysable and may be administered without regard to the timing of 
hemodialysis.

Paediatric population
The pharmacokinetics of anidulafungin after at least 5 daily doses were investigated in 24 
immunocompromised paediatric (2 to 11 years old) and adolescent (12 to 17 years old) patients with 
neutropenia. Steady state was achieved on the first day after a loading dose (twice the maintenance 
dose), and steady state Cmax and AUCss increase in a dose-proportional manner. Systemic exposure 
following daily maintenance dose of 0.75 and 1.5 mg/kg/day in this population were comparable to 
those observed in adults following 50 and 100 mg/day, respectively. Both regimens were well-
tolerated by these patients. 

The pharmacokinetics of anidulafungin was investigated in 66 paediatric patients (1 month to 
< 18 years) with ICC in a prospective, open-label, non-comparative paediatric study following 
administration of 3.0 mg/kg loading dose and 1.5 mg/kg/day maintenance dose (see section 5.1).
Based on population pharmacokinetic analysis of combined data from adult and paediatric patients 
with ICC, the mean exposure parameters (AUC0-24,ss and Cmin,ss) at steady state in the overall paediatric 
patients across age groups (1 month to < 2 years, 2 to < 5 years, and 5 to < 18 years) were comparable 
to those in adults receiving 200 mg loading dose and 100 mg/day maintenance dose. Body weight 
adjusted CL (L/h/kg) and volume of distribution at steady state (L/kg) were similar across the age 
groups.



14

5.3 Preclinical safety data

In 3 month studies, evidence of liver toxicity, including elevated enzymes and morphologic 
alterations, was observed in both rats and monkeys at doses 4- to 6-fold higher than the anticipated 
clinical therapeutic exposure. In vitro and in vivo genotoxicity studies with anidulafungin provided no 
evidence of genotoxic potential. Long-term studies in animals have not been conducted to evaluate the 
carcinogenic potential of anidulafungin.

Administration of anidulafungin to rats did not indicate any effects on reproduction, including male 
and female fertility.

Anidulafungin crossed the placental barrier in rats and was detected in foetal plasma. 

Embryo-foetal development studies were conducted with doses between 0.2- and 2-fold (rats) and 
between 1- and 4-fold (rabbits) the proposed therapeutic maintenance dose of 100 mg/day. 
Anidulafungin did not produce any drug-related developmental toxicity in rats at the highest dose 
tested. Developmental effects observed in rabbits (slightly reduced foetal weights) occurred only at the 
highest dose tested, a dose that also produced maternal toxicity.

The concentration of anidulafungin in the brain was low (brain to plasma ratio of approximately 0.2) 
in uninfected adult and neonatal rats after a single dose. However, brain concentrations increased in 
uninfected neonatal rats after five daily doses (brain to plasma ratio of approximately 0.7). In multiple 
dose studies in rabbits with disseminated candidiasis and in mice with central nervous system (CNS)
Candida infection, anidulafungin has been shown to reduce fungal burden in the brain. Results of 
pharmacokinetic-pharmacodynamic studies in rabbit models of disseminated candidiasis and 
hematogenous Candida meningoencephalitis indicated that higher doses of anidulafungin were needed 
to optimally treat infections of CNS tissues relative to non-CNS tissues (see section 4.4).

Rats were dosed with anidulafungin at three dose levels and anaesthetised within one hour using a 
combination of ketamine and xylazine. Rats in the high dose group experienced infusion-related 
reactions that were exacerbated by anaesthesia. Some rats in the mid dose group experienced similar 
reactions but only after administration of anaesthesia. There were no adverse reactions in the low-dose 
animals in the presence or absence of anaesthesia, and no infusion-related reactions in the mid-dose 
group in the absence of anaesthesia. 

Studies conducted in juvenile rats did not indicate a greater susceptibility to anidulafungin 
hepatotoxicity compared to adult animals.

6 PHARMACEUTICAL PARTICULARS

6.1 List of excipients

Fructose 
Mannitol 
Polysorbate 80
Tartaric acid 
Sodium hydroxide (for pH-adjustment)
Hydrochloric acid (for pH-adjustment)

6.2 Incompatibilities

This medicinal product must not be mixed with other medicinal products or electrolytes except those 
mentioned in section 6.6.



15

6.3 Shelf life

3 years

Excursions for 96 hours up to 25ºC are permitted, and the powder can be returned to refrigerated 
storage.

Reconstituted solution

The reconstituted solution may be stored at up to 25°C for up to 24 hours.

Chemical and physical in-use stability of the reconstituted solution has been demonstrated for 24 hours
at 25ºC.

From a microbiological point of view, following good aseptic practices, the reconstituted solution can 
be utilized for up to 24 hours when stored at 25ºC.

Infusion solution

The infusion solution may be stored at 25ºC for 48 hours.

Do not freeze.

Chemical and physical in-use stability of the infusion solution has been demonstrated for 48 hours at 
25ºC.

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 25ºC.

6.4 Special precautions for storage

Store in a refrigerator (2C – 8C).

For storage conditions after reconstitution and dilution of the medicinal product, see section 6.3.

6.5 Nature and contents of container

30 mL Type 1 glass vial with an elastomeric stopper (butyl rubber with an inert polymer coating on 
the product contact surface and lubricant on the top surface for easier machinability, or alternatively 
bromobutyl rubber with a lubricant) and aluminium seal with flip-off cap.

Pack size of 1 vial.

6.6 Special precautions for disposal and other handling

There are no special requirements for disposal.

ECALTA must be reconstituted with water for injection and subsequently diluted with ONLY sodium 
chloride 9 mg/mL (0.9%) solution for injection or 50 mg/mL (5%) glucose for infusion. The 
compatibility of reconstituted ECALTA with intravenous substances, additives, or medicines other 
than 9 mg/mL (0.9%) sodium chloride for infusion or 50 mg/mL (5%) glucose for infusion has not 
been established. The infusion solution must not be frozen.



16

Reconstitution

Aseptically reconstitute each vial with 30 mL water for injection to provide a concentration of 
3.33 mg/mL. The reconstitution time can be up to 5 mins. After subsequent dilution, the solution is to 
be discarded if particulate matter or discoloration is identified.

Dilution and infusion

Aseptically transfer the contents of the reconstituted vial(s) into an intravenous bag (or bottle) 
containing either 9 mg/mL (0.9%) sodium chloride for infusion or 50 mg/mL (5%) glucose for 
infusion obtaining an anidulafungin concentration of 0.77 mg/mL. The table below provides the 
volumes required for each dose. 

Dilution requirements for ECALTA administration

Dose Number
of vials of 
powder 

Total 
reconstituted 

volume

Infusion 
volume A

Total 
infusion 
volumeB

Rate of 
infusion

Minimum 
duration of 

infusion

100 mg 1 30 mL 100 mL 130 mL 1.4 mL/
min

90 min

200 mg 2 60 mL 200 mL 260 mL 1.4 mL
/min

180 min

A Either 9 mg/mL (0.9%) sodium chloride for infusion or 50 mg/mL (5%) glucose for infusion.  
B Infusion solution concentration is 0.77 mg/mL

The contents of a reconstituted vial should be diluted according to the above table to achieve a final 
infusion solution concentration of 0.77 mg/mL. For paediatric patients aged 1 month to < 18 years, the 
volume of infusion solution required to deliver the dose will vary depending on the weight of the 
patient (see section 4.2).

The rate of infusion should not exceed 1.1 mg/min (equivalent to 1.4 mL/min when reconstituted and 
diluted per instructions) (see sections 4.2, 4.4 and 4.8).

The solution should be inspected visually for particulate matter and discoloration prior to 
administration. If either particulate matter or discolouration are identified, discard the solution. 

Any unused medicinal product or waste material should be disposed of in accordance with local 
requirements. 

7. MARKETING AUTHORISATION HOLDER

Pfizer Europe MA EEIG
Boulevard de la Plaine 17
1050 Bruxelles
Belgium

8. MARKETING AUTHORISATION NUMBER(S) 

EU/1/07/416/002



17

9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

Date of first authorisation: 20 September 2007
Date of latest renewal: 28 August 2017

10. DATE OF REVISION OF THE TEXT

Detailed information on this medicinal product is available on the website of the European Medicines 
Agency http://www.ema.europa.eu.

http://www.ema.europa.eu/


18

ANNEX II

A. MANUFACTURER RESPONSIBLE FOR BATCH RELEASE

B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY 
AND USE

C. OTHER CONDITIONS AND REQUIREMENTS OF THE 
MARKETING AUTHORISATION

D. CONDITIONS OR RESTRICTIONS WITH REGARD TO 
THE SAFE AND EFFECTIVE USE OF THE MEDICINAL 
PRODUCT



19

A. MANUFACTURER RESPONSIBLE FOR BATCH RELEASE

Name and address of the manufacturer responsible for batch release

Pfizer Manufacturing Belgium NV
Rijksweg 12
2870 Puurs
Belgium

B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE

Medicinal product subject to restricted medical prescription (see Annex I: Summary of Product 
Characteristics, section 4.2).

C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 
AUTHORISATION


 Periodic Safety Update Reports 

The requirements for submission of periodic safety update reports for this medicinal product are set 
out in the list of Union reference dates (EURD list) provided for under Article 107c(7) of Directive 
2001/83/EC and any subsequent updates published on the European medicines web-portal.

D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND
EFFECTIVE USE OF THE MEDICINAL PRODUCT 

 Risk Management Plan (RMP) 

The MAH shall perform the required pharmacovigilance activities and interventions detailed in the 
agreed RMP presented in Module 1.8.2 of the Marketing Authorisation and any agreed subsequent 
updates of the RMP.

An updated RMP should be submitted:
 At the request of the European Medicines Agency;
 Whenever the risk management system is modified, especially as the result of new information 

being received that may lead to a significant change to the benefit/risk profile or as the result of 
an important (pharmacovigilance or risk minimisation) milestone being reached. 



20

ANNEX III

LABELLING AND PACKAGE LEAFLET



21

A. LABELLING



22

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 

Outer Carton

1. NAME OF THE MEDICINAL PRODUCT

ECALTA 100 mg powder for concentrate for solution for infusion
anidulafungin

2. STATEMENT OF ACTIVE SUBSTANCE(S)

Each vial contains 100 mg anidulafungin.

The reconstituted solution contains 3.33 mg/mL anidulafungin and the diluted solution contains 
0.77 mg/mL anidulafungin.

3. LIST OF EXCIPIENTS

Excipients: fructose, mannitol, polysorbate 80, tartaric acid, NaOH and/or HCl.

4. PHARMACEUTICAL FORM AND CONTENTS

1 vial 

Powder for concentrate for solution for infusion

5. METHOD AND ROUTE(S) OF ADMINISTRATION

Read the package leaflet before use.

For intravenous use only.

6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 
OF THE SIGHT AND REACH OF CHILDREN

Keep out of the sight and reach of children.

7. OTHER SPECIAL WARNING(S), IF NECESSARY

8. EXPIRY DATE

EXP {MONTH – YYYY}



23

9. SPECIAL STORAGE CONDITIONS

Store in a refrigerator.

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 
OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE

11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER

Pfizer Europe MA EEIG
Boulevard de la Plaine 17
1050 Bruxelles
Belgium

12. MARKETING AUTHORISATION NUMBER(S)

EU/1/07/416/002

13. BATCH NUMBER

Lot {number}

14. GENERAL CLASSIFICATION FOR SUPPLY

15. INSTRUCTIONS ON USE

16. INFORMATION IN BRAILLE

[Justification for not including Braille accepted.]

17. UNIQUE IDENTIFIER – 2D BARCODE

2D barcode carrying the unique identifier included.

18. UNIQUE IDENTIFIER – HUMAN READABLE DATA

PC:
SN:
NN:



24

MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING UNITS

Vial label

1. NAME OF THE MEDICINAL PRODUCT AND ROUTE(S) OF ADMINISTRATION

ECALTA 100 mg powder for concentrate for solution for infusion
anidulafungin
IV

2. METHOD OF ADMINISTRATION

Read the package leaflet before use

3. EXPIRY DATE

EXP {MM/YYYY}

4. BATCH NUMBER

Lot {number}

5. CONTENTS BY WEIGHT, BY VOLUME OR BY UNIT

100 mg

6. OTHER

Store in a refrigerator 



25

B. PACKAGE LEAFLET



26

Package leaflet: Information for the user

ECALTA 100 mg powder for concentrate for solution for infusion
Anidulafungin

Read all of this leaflet carefully before you or your child start using this medicine because it 
contains important information for you.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor or pharmacist or nurse.
- If you or your child get any side effects, talk to your doctor, or pharmacist or nurse. This

includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet: 

1. What ECALTA is and what it is used for
2. What you need to know before you or your child use ECALTA
3. How to use ECALTA
4. Possible side effects
5. How to store ECALTA 
6. Contents of the pack and other information

1. What ECALTA is and what it is used for

ECALTA contains the active substance anidulafungin and is prescribed in adults and in paediatric 
patients aged 1 month to less than 18 years to treat a type of fungal infection of the blood or other 
internal organs called invasive candidiasis. The infection is caused by fungal cells (yeasts) called 
Candida.

ECALTA belongs to a group of medicines called echinocandins. These medicines are used to treat 
serious fungal infections.

ECALTA prevents normal development of fungal cell walls. In the presence of ECALTA, fungal cells 
have incomplete or defective cell walls, making them fragile or unable to grow.

2. What you need to know before you or your child use ECALTA

Do not use ECALTA
- if you are allergic to anidulafungin, other echinocandins (e.g. caspofungin acetate), or any of the 

other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor or pharmacist or nurse before using ECALTA.

Your doctor may decide to monitor you
- for liver function more closely if you develop liver problems during your treatment
- if you are given anaesthetics during your treatment with ECALTA for signs of an allergic 

reaction such as itching, wheezing, blotchy skin
- for signs of an infusion–related reaction which could include a rash, hives, itching, redness
- for shortness of breath/breathing difficulties, dizziness or lightheadedness

Children and adolescents

ECALTA should not be given to patients under 1 month of age.



27

Other medicines and ECALTA

Tell your doctor or pharmacist if you or your child are taking, have recently taken or might take any 
other medicines.

Pregnancy and breast-feeding

The effect of ECALTA in pregnant women is not known. Therefore ECALTA is not recommended 
during pregnancy. Effective contraception should be used in women of childbearing age. Contact your
doctor immediately if you become pregnant while taking ECALTA.

The effect of ECALTA in breast-feeding women is not known. Ask your doctor or pharmacist for 
advice before taking ECALTA while breast-feeding.

Ask your doctor or pharmacist for advice before taking any medicines.

ECALTA contains fructose

This medicine contains fructose (a type of sugar). If you have been told by your doctor that you have 
an intolerance to some sugars, contact your doctor before taking this medicinal product. 

If you (or your child) have hereditary fructose intolerance (HFI), a rare genetic disorder, you (or your 
child) must not receive this medicine. Patients with HFI cannot break down fructose in this medicine, 
which may cause serious side effects.

You must tell your doctor before receiving this medicine if you (or your child) have HFI or if your 
child can no longer take sweet foods or drinks because they feel sick, vomit or get unpleasant effects 
such as bloating, stomach cramps or diarrhoea.

3. How to use ECALTA

ECALTA will always be prepared and given to you or your child by a doctor or a healthcare 
professional (there is more information about the method of preparation at the end of the leaflet in the 
section for medical and healthcare professionals only).

For use in adults, the treatment starts with 200 mg on the first day (loading dose). This will be 
followed by a daily dose of 100 mg (maintenance dose).  

For use in children and adolescents (age from 1 month to less than 18 years), the treatment starts with 
3.0 mg/kg (not to exceed 200 mg) on the first day (loading dose). This will be followed by a daily dose 
of 1.5 mg/kg (not to exceed 100 mg) (maintenance dose). The dose that is given depends on the 
patient’s weight.

ECALTA should be given to you once a day, by slow infusion (a drip) into your vein. For adults, this
will take at least 1.5 hours for the maintenance dose and 3 hours for the loading dose. For children and 
adolescents, the infusion may take less time depending on the patient’s weight.

Your doctor will determine the duration of your treatment and how much ECALTA you will receive 
each day and will monitor your response and condition.

In general, your treatment should continue for at least 14 days after the last day Candida was found in 
your blood.



28

If you receive more ECALTA than you should

If you are concerned that you may have been given too much ECALTA, tell your doctor or another 
healthcare professional immediately.

If you forgot to use ECALTA

As you will be given this medicine under close medical supervision, it is unlikely that a dose would be 
missed. However tell your doctor or pharmacist if you think that a dose has been forgotten.

You should not be given a double dose by doctor.

If you stop using ECALTA

You should not experience any effects from ECALTA if your doctor stops ECALTA treatment.

Your doctor may prescribe another medicine following your treatment with ECALTA to continue 
treating your fungal infection or prevent it from returning.

If your original symptoms come back, tell your doctor or another healthcare professional immediately.

If you have any further questions on the use of this medicine, ask your doctor, or pharmacist or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Some of 
these side effects will be noted by your doctor while monitoring your response and condition.

Life-threatening allergic reactions that might include difficulty breathing with wheezing or worsening
of an existing rash have been rarely reported during administration of ECALTA.

Serious side effects – tell your doctor or another healthcare professional immediately should any
of the following occur:
- Convulsion (seizure)
- Flushing
- Rash, pruritis (itching)
- Hot flush
- Hives
- Sudden contraction of the muscles around the airways resulting in wheezing or coughing
- Difficulty of breathing

Other side effects

Very common side effects (may affect more than 1 in 10 people) are: 

- Low blood potassium (hypokalaemia)
- Diarrhoea
- Nausea

Common side effects (may affect up to 1 in 10 people) are:

- Convulsion (seizure)
- Headache
- Vomiting
- Changes in blood tests of liver function
- Rash, pruritis (itching)



29

- Changes in blood tests of kidney function
- Abnormal flow of bile from the gallbladder into the intestine (cholestasis)
- High blood sugar
- High blood pressure
- Low blood pressure
- Sudden contraction of the muscles around the airways resulting in wheezing or coughing
- Difficulty of breathing

Uncommon side effects (may affect up to 1 in 100 people) are:

- Disorder of blood clotting system
- Flushing
- Hot flush
- Stomach pain 
- Hives
- Pain at injection site

Not known (frequency cannot be estimated from the available data) are:

- Life-threatening allergic reactions 

Reporting of side effects 
If you get any side effects, talk to your doctor or, pharmacist or nurse. This includes any possible side 
effects not listed in this leaflet. You can also report side effects directly via the national reporting 
system listed in Appendix V. By reporting side effects you can help provide more information on the 
safety of this medicine.

5. How to store ECALTA 

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the label. The expiry data refers to the 
last day of that month.

Store in a refrigerator (2C – 8C).

The reconstituted solution may be stored up to 25C for up to 24 hours. The infusion solution may be 
stored at 25°C (room temperature) for 48 hours (do not freeze) and should be administered at 25C 
(room temperature) within 48 hours.

Do not throw away any medicines via wastewater or household waste. 

6. Contents of the pack and other information

What ECALTA contains

- The active substance is anidulafungin. Each vial of powder contains 100 mg anidulafungin. 
- The other ingredients are: fructose, mannitol, polysorbate 80, tartaric acid, sodium hydroxide 

(for pH-adjustment), hydrochloric acid (for pH-adjustment)

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


30

What ECALTA looks like and contents of the pack

ECALTA is supplied as a box containing 1 vial of 100 mg powder for concentrate for solution for 
infusion.

The powder is white to off-white.  

Marketing Authorisation Holder 

Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium

Manufacturer

Pfizer Manufacturing Belgium NV, Rijksweg 12, 2870 Puurs, Belgium

For any information about this medicine, please contact the local representative of the Marketing 
Authorisation Holder:

België /Belgique/Belgien Lietuva
Pfizer S.A./N.V. Pfizer Luxembourg SARL 

filialas Lietuvoje
Tél/Tel: +32 (0)2 554 62 11 Tel. +3705 2514000

България Luxembourg/Luxemburg
Пфайзер Люксембург САРЛ, Клон България Pfizer S.A.
Тел.: +359 2 970 4333 Tél: +32 (0)2 554 62 11

Česká republika Magyarország
Pfizer s.r.o. Pfizer Kft.
Tel: +420-283-004-111 Tel. + 36 1 488 37 00

Danmark Malta
Pfizer ApS Vivian Corporation Ltd.
Tlf: +45 44 20 11 00 Tel : +356 21344610

Deutschland Nederland
Pfizer Pharma PFE GmbH Pfizer bv
Tel: +49 (0)800 8535555 Tel: +31 (0)10 406 43 01

Eesti Norge
Pfizer Luxembourg SARL Eesti filiaal Pfizer AS
Tel: +372 666 7500 Tlf: +47 67 52 61 00

Ελλάδα

Pfizer ΕΛΛΑΣ A.E.

Τηλ.: +30 210 6785 800

Österreich
Pfizer Corporation Austria Ges.m.b.H.
Tel: +43 (0)1 521 15-0

España Polska
Pfizer, S.L. Pfizer Polska Sp. z o.o.,
Tel: +34 91 490 99 00 Tel.: +48 22 335 61 00

France Portugal
Pfizer Laboratórios Pfizer, Lda.
Tél: +33 (0)1 58 07 34 40 Tel: + 351 214 235 500



31

Hrvatska România
Pfizer Croatia d.o.o.
Tel: + 385 1 3908 777

Pfizer România S.R.L
Tel: +40 (0)21 207 28 00

Ireland Slovenija
Pfizer Healthcare Ireland
Tel: 1800 633 363 (toll free)
Tel: +44 (0)1304 616161

Pfizer Luxembourg SARL
Pfizer, podružnica za svetovanje s področja 
farmacevtske dejavnosti, Ljubljana
Tel: + 386 (0)152 11 400

Ísland Slovenská republika
Icepharma hf., Pfizer Luxembourg SARL, organizačná zložka
Sími: + 354 540 8000 Tel: +421-2-3355 5500

Italia Suomi/Finland
Pfizer S.r.l. Pfizer Oy
Tel: +39 06 33 18 21 Puh/Tel: +358(0)9 43 00 40

Kύπρος

Pfizer ΕΛΛΑΣ Α.Ε. (Cyprus Branch) 

Τηλ: +357 22 817690

Sverige
Pfizer AB
Tel: +46 (0)8 5505 2000

Latvija United Kingdom
Pfizer Luxembourg SARL
Filiāle Latvijā

Pfizer Limited

Tel: +371 670 35 775 Tel: +44 (0)1304 616161

This leaflet was last revised in {MM/YYYY}.

Detailed information on this medicine is available on the European Medicines Agency web site: 
http://www.ema.europa.eu.

<--------------------------------------------------------------------------------------------------------------------------
The following information is intended for medical or healthcare professionals only and applies only to 
the single vial ECALTA 100 mg powder for concentrate for solution for infusion presentation:

The contents of the vial must be reconstituted with water for injection and subsequently diluted with 
ONLY 9 mg/mL (0.9%) sodium chloride for infusion or 50 mg/mL (5%) glucose for infusion. The 
compatibility of reconstituted ECALTA with intravenous substances, additives, or medicines other 
than 9 mg/mL (0.9%) sodium chloride for infusion or 50 mg/mL (5%) glucose for infusion has not 
been established. The infusion solution must not be frozen.

Reconstitution
Aseptically reconstitute each vial with 30 mL water for injection to provide a concentration of 
3.33 mg/mL. The reconstitution time can be up to 5 minutes. After subsequent dilution, the solution is 
to be discarded if particulate matter or discoloration is identified.

The reconstituted solution may be stored up to 25°C for up to 24 hours prior to further dilution.

Dilution and infusion
Aseptically transfer the contents of the reconstituted vial(s) into an intravenous bag (or bottle) 
containing either 9 mg/mL (0.9%) sodium chloride for infusion or 50 mg/mL (5%) glucose for 
infusion obtaining an anidulafungin final infusion solution concentration of 0.77 mg/mL. For children 
and adolescents, the volume of infusion solution required to deliver the dose will vary depending on 
the patient’s weight. The table below provides the volumes required for each dose. 

http://www.ema.europa.eu/


32

Dilution requirements for ECALTA administration

Dose Number
of vials of 
powder 

Total 
reconstituted 

volume

Infusion 
volume A

Total 
infusion 
volume B

Rate of 
infusion

Minimum 
duration of 

infusion

100 mg 1 30 mL 100 mL 130 mL 1.4 mL/
min

90 min

200 mg 2 60 mL 200 mL 260 mL 1.4 mL/
min

180 min

A Either 9 mg/mL (0.9%) sodium chloride for infusion or 50 mg/mL (5%) glucose for infusion.  
B Infusion solution concentration is 0.77 mg/mL

The rate of infusion should not exceed 1.1 mg/min (equivalent to 1.4 mL/min when reconstituted and 
diluted per instructions).

Parenteral medicinal products should be inspected visually for particulate matter and discoloration 
prior to administration, whenever solution and container permit. If either particulate matter or 
discolouration are identified, discard the solution. 

For single use only. Waste materials should be disposed of in accordance with local requirements.


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