• Invasive aspergillosis refractory to, or intolerant of, other therapies.
• Candidemia and associated serious infections (intra-abdominal abscesses, peritonitis, pleural space infections).
• Esophageal candidiasis.
• Suspected fungal infections in febrile neutropenic patients.

Contraindicated in:

• Hypersensitivity
• OB: Pregnancy.

Use Cautiously in:

• Moderate hepatic impairment (↓ maintenance dose recommended)
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant.

Derm: flushing, pruritus, rash, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS.

GI: ↑liver enzymes, diarrhea, nausea, vomiting.

GU: ↑serum creatinine.

Local: venous irritation at injection site.

Neuro: headache.

Resp: bronchospasm.
Misc: chills, fever, (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• ↑risk of hepatotoxicity with Cyclosporine; closely monitor liver enzymes during concurrent therapy.
• May ↓ levels and effectiveness of tacrolimus.
• Rifampin may ↓ levels and effectiveness; maintenance dose should be ↑ to 70 mg/day (in patients with normal hepatic function).
• Efavirenz, nelfinavir, nevirapine, phenytoin, dexamethasone, or carbamazepine may ↓ levels and effectiveness; an ↑ in the maintenance dose to 70 mg/day should be considered in patients who are not clinically responding.

(Generic available)

• Powder for injection: 50 mg/vial; 70 mg/vial;

• IV (Adults): 70 mg initially followed by 50 mg once daily; duration determined by clinical situation and response; Esophageal candidiasis: 50 mg once daily; duration determined by clinical situation and response.
• IV (Children 3 mo): 70 mg/m² (max = 70 mg) initially followed by 50 mg/m² once daily (max = 70 mg/day); duration determined by clinical situation and response.
• IV (Infants 1 to <3 mo and Neonates): 25 mg/m² once daily.

Cancidas

• Inhibits the synthesis of (1, 3)-D-glucan, a necessary component of the fungal cell wall.

• Death of susceptible fungi.

Therapeutic Classification: antifungals

Pharmacologic Classification: echinocandins

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Protein Binding: 97%.

Metabolism/Excretion: Slowly and extensively metabolized; <1.5% excreted unchanged in urine.

Half-life: Polyphasic: phase: 9–11 hr; phase: 40–50 hr.

• Explain the purpose of caspofungin to patient and family.
• Advise patient to notify health care professional immediately if symptoms of allergic reactions (rash, facial swelling, pruritus, sensation of warmth, difficulty breathing) occur.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

kas-po-FUN-gin