FDA-approved
Heart & blood
Echinocandins
Also called caspofungin, micafungin, anidulafungin
Echinocandins are FDA-approved antifungal lipopeptides that block the fungal cell wall. Learn how caspofungin, micafungin, and anidulafungin work and are used.
- Reviewed by
- William Maish, MD MBA MPH, Clinical Product Lead
- Published
- October 5, 2026
- Last updated
- October 5, 2026
Key takeaway
The echinocandins (caspofungin, micafungin, and anidulafungin; sold as Cancidas, Mycamine, and Eraxis) are antifungal lipopeptides that attack the fungal cell wall, a structure human cells lack. They are a preferred option for invasive Candida infections and are generally well tolerated. All three have been FDA-approved in the U.S. since the 2000s, a fourth (rezafungin, sold as Rezzayo) was approved in 2023, and all are given intravenously.
At a glance
| What they are | Echinocandin antifungal lipopeptides that block fungal cell-wall synthesis |
| Approved for | Invasive candidiasis and candidemia, esophageal candidiasis, and (caspofungin) some aspergillosis and febrile neutropenia |
| Key fact | Caspofungin was at least as effective as amphotericin B for invasive candidiasis, with fewer side effects |
| Route | Intravenous |
| Evidence strength | FDA approved |
What are the echinocandins?
The echinocandins are a class of antifungal drugs, semi-synthetic cyclic lipopeptides, that includes caspofungin (Cancidas), micafungin (Mycamine), and anidulafungin (Eraxis). They are used mainly for serious Candida infections and have become a preferred option because they combine strong activity with a clean safety profile. Caspofungin, the first in the class, was approved in the United States in 2001, followed by micafungin in 2005 and anidulafungin in 2006. A newer member of the class, rezafungin (Rezzayo), was approved in 2023 and is given once a week.
How do they work?
Echinocandins target the fungal cell wall, specifically the enzyme 1,3-beta-D-glucan synthase. This enzyme builds 1,3-beta-D-glucan, a structural sugar polymer that gives the fungal wall its integrity. By blocking it, echinocandins weaken the wall until the fungal cell can no longer withstand internal pressure and ruptures. They are fungicidal against most Candida species and fungistatic against Aspergillus.
A key advantage is selectivity: human cells have no cell wall and no equivalent of this enzyme, so echinocandins cause relatively little direct toxicity to the patient. Caspofungin, micafungin, and anidulafungin are given intravenously once daily, and rezafungin once weekly. In its pivotal trial, caspofungin was at least as effective1 as amphotericin B for invasive candidiasis while causing fewer adverse effects, and anidulafungin outperformed fluconazole on the primary measure in its own trial.
Is it FDA-approved?
Yes. Caspofungin, micafungin, and anidulafungin are all FDA-approved, as is rezafungin; the table shows each one's approval year and approved uses.
| Drug | FDA approval | Approved uses include |
| Caspofungin | 2001 | Candidemia, invasive candidiasis, and esophageal candidiasis; additionally, empiric therapy in febrile neutropenia and invasive aspergillosis refractory to or intolerant of other therapy |
| Micafungin | 2005 | Candidemia, invasive candidiasis, and esophageal candidiasis; additionally, Candida prophylaxis in stem-cell transplant recipients |
| Anidulafungin | 2006 | Candidemia, invasive candidiasis, and esophageal candidiasis |
| Rezafungin | 2023 | Candidemia and invasive candidiasis in adults with limited or no other treatment options |
None carry a boxed warning.
What are they prescribed for?
Echinocandins are prescribed for invasive Candida infections, including candidemia, and for esophageal candidiasis. Caspofungin is also used for suspected fungal infection in neutropenic fever and for certain Aspergillus infections, and micafungin for preventing Candida infection during stem-cell transplantation.
What are the side effects?
Common side effects include:
- Fever
- Infusion-related reactions such as flushing, rash, or itching
- Nausea and headache
- Low potassium and raised liver enzymes
More serious considerations include:
- Liver effects and, rarely, more significant liver dysfunction
- Rare severe allergic reactions
- Dose adjustment for caspofungin in liver impairment and some drug interactions
More for heart & blood
Sources: FDA prescribing information for Cancidas, Mycamine, Eraxis, and Rezzayo; the caspofungin trial (Mora-Duarte et al., The New England Journal of Medicine, 2002, DOI: 10.1056/NEJMoa0215851) and the anidulafungin trial (Reboli et al., The New England Journal of Medicine, 2007, DOI: 10.1056/NEJMoa0669062), both indexed on PubMed. This document is educational and does not constitute medical advice.