caspofungin

REMS

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.

Contraind./Precautions ⬆ ⬇

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.

Adv. Reactions/Side Effects ⬆ ⬇

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, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)

Interactions ⬆ ⬇

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.

Availability ⬆ ⬇

(Generic available)

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

Route/Dosage ⬆ ⬇

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.

Hepatic Impairment

IV (Adults ): Moderate hepatic impairment: 70 mg initially followed by 35 mg once daily; duration determined by clinical situation and response.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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

Therapeutic effects:

Death of susceptible fungi.

Classifications ⬆ ⬇

Therapeutic Classification: antifungals

Pharmacologic Classification: echinocandins

Pharmacokinetics ⬆ ⬇

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: βphase: 9–11 hr; γphase: 40–50 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	unknown	end of infusion	24 hr

Patient/Family Teaching ⬆ ⬇

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.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

section name header

Indications ⬇