Peptide Graded

Echinocandins

Is Echinocandins safe?

Well tolerated in trial and label data

AStrong human evidenceFDA approvedas of 2026-10-26

Patients tolerate echinocandins well. In the caspofungin trial, far fewer patients had to stop the drug than with amphotericin B. Common effects across the class are fever, vein irritation at the infusion site, headache and nausea. Liver enzymes can rise briefly. Fast infusion can cause histamine-type reactions such as flushing and rash. Micafungin's label notes liver tumors in rats at high exposure. No such signal has appeared in humans. 123

Resistance has emerged in Candida glabrata and Candida auris. It comes mainly from mutations in the FKS genes, which code for the target enzyme. It is the main long-term concern for the class. 23

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Citations

  1. Mora-Duarte 2002, NEJM: comparison of caspofungin and amphotericin B for invasive candidiasis doi.org
  2. Reboli 2007, NEJM: anidulafungin versus fluconazole for invasive candidiasis doi.org
  3. Rezzayo (rezafungin) prescribing information drugs.com

Reference information only, not medical advice. Drawn from the Echinocandins article, fact-checked against the cited sources. No dosing anywhere on this site.