AHFS Class:

8:14.16 Echinocandins

Caspofungin acetate is available in 2 different formulations.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ In addition to varying inactive ingredients, the formulations differ in their storage requirements.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

Caspofungin acetate (Cancidas, Merck; generic) is available as a lyophilized powder or cake in single-use vials containing 50 or 70 mg of caspofungin.³³⁴⁴; ³³⁴⁶ The 50-mg vial also contains sucrose 39 mg, mannitol 26 mg, and glacial acetic acid 2 mg.³³⁴⁴; ³³⁴⁶ The 70-mg vial also contains sucrose 54 mg, mannitol 36 mg, and glacial acetic acid 2.7 mg.³³⁴⁴; ³³⁴⁶ Both vial sizes contain sodium hydroxide to adjust the pH.³³⁴⁴; ³³⁴⁶ The 50- and 70-mg vials contain an overfill of caspofungin (4.6 and 5.6 mg, respectively) to permit withdrawal of a full 50- or 70-mg dose of the reconstituted product.³³⁴⁴; ³³⁴⁶

Caspofungin acetate (Fresenius Kabi) is available as a lyophilized powder or cake in single-use vials containing 50 or 70 mg of caspofungin.³³⁴⁵ The 50- and 70-mg vials also contain arginine 100 and 140 mg, respectively.³³⁴⁵ Both vial sizes contain hydrochloric acid and/or sodium hydroxide to adjust the pH.³³⁴⁵ The 50- and 70-mg vials contain an overfill of caspofungin (4.6 and 7.2 mg, respectively) to permit withdrawal of a full 50- or 70-mg dose of the reconstituted product.³³⁴⁵

To prepare a solution of caspofungin for intravenous infusion, vials of caspofungin acetate that have been stored under refrigeration should be allowed to come to room temperature prior to reconstitution.³³⁴⁴; ³³⁴⁶ Both the 50- and 70-mg vials should be reconstituted with 10.8 mL of sterile water for injection, sodium chloride 0.9%, or bacteriostatic water for injection (containing methyl- or propylparabens or benzyl alcohol 0.9%) and should be mixed gently until the powder or cake has completely dissolved and a clear solution forms.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ The resulting caspofungin concentrations of the reconstituted solutions prepared from the 50- and 70-mg vials are 5 and 7 mg/mL, respectively.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ To prepare doses intended for pediatric patients, manufacturers recommend use of the 50-mg vial for doses less than or equal to 50 mg; the 70-mg vial should be reserved for pediatric doses exceeding 50 mg.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

The reconstituted caspofungin solution should be diluted for infusion within 1 hour after reconstitution.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ The appropriate volume of the reconstituted solution should be withdrawn from the vial and transferred to a 250-mL bag or bottle of sodium chloride 0.9%, sodium chloride 0.45%, sodium chloride 0.225%, or Ringer’s injection, lactated.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ Alternatively, the appropriate volume of the reconstituted solution may be added to a smaller volume of these infusion solutions for a final caspofungin concentration not exceeding 0.5 mg/mL.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ Reconstituted and diluted solutions should be visually inspected for particulate matter and discoloration; if the solution has precipitated or if cloudiness occurs, the solution should not be used.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

pH

The pH of a saturated aqueous solution of caspofungin is approximately 6.6.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

Osmolality

Caspofungin acetate diluted as directed for infusion is near isotonicity.²⁷²²

Trade Name(s)

Cancidas

Caspofungin acetate is administered by slow intravenous infusion over approximately 1 hour.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ Caspofungin acetate should not be administered by intravenous bolus.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

Caspofungin acetate is available as a lyophilized white to off-white cake or powder that forms a clear solution upon reconstitution.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ Intact vials of caspofungin acetate (Cancidas, Merck; generic) should be stored at 2 to 8°C.³³⁴⁴; ³³⁴⁶ Intact vials of caspofungin acetate (Fresenius Kabi) should be stored at controlled room temperature.³³⁴⁵ Vials are for single use only; unused portions should be discarded.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

The reconstituted solution may be stored for up to 1 hour after reconstitution at room temperature up to 25°C, but should be withdrawn within 1 hour after reconstitution to prepare the intravenous infusion solution.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

The diluted solution for infusion in the intravenous bag or bottle must be used within 24 hours if stored at room temperature up to 25°C or within 48 hours if stored at 2 to 8°C.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

Caspofungin acetate is unstable in dextrose-containing solutions; such solutions should not be used for reconstitution or dilution of the drug.³³⁴⁴; ³³⁴⁵; ³³⁴⁶ The manufacturers recommend that caspofungin acetate not be mixed with or co-infused with other drugs.³³⁴⁴; ³³⁴⁵; ³³⁴⁶

Solution Compatibility

Y-Site Injection Compatibility (1:1 Mixture)

Additional Compatibility Information

Infusion Solutions

In a simulated Y-site administration study, caspofungin acetate (Fresenius Kabi) at a caspofungin concentration of 0.28 mg/mL in sodium chloride 0.9% was physically compatible with Normosol R for up to 4 hours at 21°C protected from light.³⁷¹⁹

For a list of references cited in the text of this monograph, search the monograph titled References.

ASHP^® Injectable Drug Information^TM. Selected Revisions March 31, 2024. © Copyright, 2024. American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.