kas-po-FUN-gin

Therapeutic Classification: antifungals

Pharmacologic Classification: echinocandins

• 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.

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

• Death of susceptible fungi.

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.

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, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA).

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.

• 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.

(Generic available)

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

• Assess patient for signs and symptoms of fungal infections prior to and periodically during therapy.
• Assess for skin rash frequently during therapy. Discontinue at first sign of rash; may be life-threatening. SJS may develop. Treat symptomatically; may recur once treatment is stopped.
• Monitor patient for signs of anaphylaxis (rash, dyspnea, stridor, facial swelling, angioedema, pruritus, sensation of warmth, bronchospasm) during therapy.

• May cause ↑ serum alkaline phosphatase, serum creatinine, AST, ALT, eosinophils, and urine protein and RBCs. May also cause ↓ serum potassium, hemoglobin, hematocrit, and WBCs.

IV Administration:

• Intermittent Infusion: Allow refrigerated vial to reach room temperature. For 70-mg or 50-mg dose: Reconstitute vials with 10.8 mL of 0.9% NaCl, sterile water for injection, bacteriostatic water for injection with methylparaben and propylparaben, or bacteriostatic water for injection with 0.9% benzyl alcohol. Use preservative-free diluents for neonates. Do not dilute with dextrose solutions. Reconstituted solution is stable for 1 hr at room temperature.
  Diluent: Withdraw 10 mL from vial and add to 250 mL of 0.9% NaCl, 0.45% NaCl, 0.225% NaCl, or LR. The 50-mg dose also can be diluted in 100 mL when volume restriction is necessary. Infusion is stable for 24 hr at room temperature or 48 hr if refrigerated. For 35-mg dose: Reconstitute a 50-mg or 70-mg vial as per the directions above. Remove the volume of drug equal to the calculated loading dose or calculated maintenance dose based on a concentration of 7 mg/mL (if reconstituted from the 70-mg vial) or a concentration of 5 mg/mL (if reconstituted from the 50-mg vial). White cake should dissolve completely. Mix gently until a clear solution is obtained. Do not use a solution that is cloudy, discolored, or contains precipitates.Concentration: 0.14–0.47 mg/mL.
• Rate: Infuse over 1 hr.
• Y-Site Compatibility:
  • alemtuzumab
  • allopurinol
  • amifostine
  • amikacin
  • aminophylline
  • amiodarone
  • anidulafungin
  • argatroban
  • arsenic trioxide
  • atracurium
  • aztreonam
  • bleomycin
  • bumetanide
  • busulfan
  • butorphanol
  • calcium acetate
  • calcium chloride
  • calcium gluconate
  • carboplatin
  • carmustine
  • chlorpromazine
  • ciprofloxacin
  • cisatracurium
  • cisplatin
  • cyclophosphamide
  • cyclosporine
  • dacarbazine
  • dactinomycin
  • daptomycin
  • daunorubicin hydrochloride
  • dexmedetomidine
  • dexrazoxane
  • diltiazem
  • diphenhydramine
  • dobutamine
  • docetaxel
  • dopamine
  • doxorubicin hydrochloride
  • doxorubicin liposomal
  • doxycycline
  • droperidol
  • epinephrine
  • epirubicin
  • erythromycin
  • esmolol
  • etoposide
  • etoposide phosphate
  • famotidine
  • fentanyl
  • fluconazole
  • fludarabine
  • ganciclovir
  • gemcitabine
  • gentamicin
  • glycopyrrolate
  • granisetron
  • haloperidol
  • hydrocortisone
  • hydromorphone
  • idarubicin
  • ifosfamide
  • imipenem/cilastatin
  • insulin, regular
  • irinotecan
  • isoproterenol
  • labetalol
  • leucovorin
  • levofloxacin
  • linezolid
  • magnesium sulfate
  • mannitol
  • melphalan
  • meperidine
  • meropenem
  • mesna
  • metoclopramide
  • metoprolol
  • midazolam
  • milrinone
  • mitomycin
  • mitoxantrone
  • morphine
  • moxifloxacin
  • mycophenolate
  • nalbuphine
  • naloxone
  • nicardipine
  • nitroglycerin
  • norepinephrine
  • octreotide
  • ondansetron
  • oxaliplatin
  • oxytocin
  • paclitaxel
  • palonosetron
  • pentamidine
  • phentolamine
  • phenylephrine
  • posaconazole
  • potassium acetate
  • potassium chloride
  • procainamide
  • prochlorperazine
  • promethazine
  • propranolol
  • remifentanil
  • rocuronium
  • succinylcholine
  • sufentanil
  • tacrolimus
  • telavancin
  • theophylline
  • thiopental
  • thiotepa
  • tigecycline
  • tirofiban
  • tobramycin
  • topotecan
  • vancomycin
  • vasopressin
  • vecuronium
  • verapamil
  • vinblastine
  • vincristine
  • vinorelbine
  • voriconazole
  • zidovudine
  • zoledronic acid
• Y-Site Incompatibility:
  • aminocaproic acid
  • amphotericin B lipid complex
  • amphotericin B liposomal
  • ampicillin
  • ampicillin/sulbactam
  • bivalirudin
  • blinatumomab
  • cefazolin
  • cefepime
  • cefotaxime
  • cefotetan
  • cefoxitin
  • ceftaroline
  • ceftazidime
  • ceftriaxone
  • cefuroxime
  • chloramphenicol
  • clindamycin
  • dantrolene
  • dexamethasone
  • diazepam
  • digoxin
  • enalaprilat
  • ephedrine
  • ertapenem
  • fluorouracil
  • foscarnet
  • fosphenytoin
  • furosemide
  • heparin
  • ketorolac
  • lidocaine
  • methotrexate
  • methylprednisolone
  • nafcillin
  • nitroprusside
  • pamidronate
  • pemetrexed
  • pentobarbital
  • phenobarbital
  • phenytoin
  • piperacillin/tazobactam
  • potassium phosphate
  • sodium acetate
  • sodium bicarbonate
  • sodium phosphate
  • trimethoprim/sulfamethoxazole
• Solution Incompatibility:
  • Solutions containing dextrose
.

• 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.

• Decrease in signs and symptoms of fungal infections. Duration of therapy is determined based on severity of underlying disease, recovery from immunosuppression, and clinical response.

Cancidas

NDC Code^*

• 0006- Merck Sharp and Dohme Corp.
  • 0006-3822- CANCIDAS
    • 0006-3822-10- 1 VIAL, SINGLE-USE in 1 CARTON (0006-3822-10) > 10.8 mL in 1 VIAL, SINGLE-USE

• 0006- Merck Sharp and Dohme Corp.
  • 0006-3823- CANCIDAS
    • 0006-3823-10- 1 VIAL, SINGLE-USE in 1 CARTON (0006-3823-10) > 10.8 mL in 1 VIAL, SINGLE-USE

• 0781- Sandoz Inc
  • 0781-3421- CASPOFUNGIN ACETATE
    • 0781-3421-94- 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3421-94) > 10.8 mL in 1 VIAL, SINGLE-DOSE (0781-3421-01)

• 0781- Sandoz Inc
  • 0781-3423- CASPOFUNGIN ACETATE
    • 0781-3423-94- 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3423-94) > 10.8 mL in 1 VIAL, SINGLE-DOSE (0781-3423-01)

• 47781- Alvogen Inc.
  • 47781-613- Caspofungin Acetate
    • 47781-613-07- 1 VIAL, SINGLE-DOSE in 1 CARTON (47781-613-07) > 10.8 mL in 1 VIAL, SINGLE-DOSE

• 47781- Alvogen Inc.
  • 47781-614- Caspofungin Acetate
    • 47781-614-07- 1 VIAL, SINGLE-DOSE in 1 CARTON (47781-614-07) > 10.8 mL in 1 VIAL, SINGLE-DOSE

• 63323- Fresenius Kabi USA, LLC
  • 63323-356- Caspofungin Acetate
    • 63323-356-10- 10 VIAL, SINGLE-DOSE in 1 CARTON (63323-356-10) > 10.8 mL in 1 VIAL, SINGLE-DOSE (63323-356-01)

• 63323- Fresenius Kabi USA, LLC
  • 63323-358- Caspofungin Acetate
    • 63323-358-10- 10 VIAL, SINGLE-DOSE in 1 CARTON (63323-358-10) > 10.8 mL in 1 VIAL, SINGLE-DOSE (63323-358-01)

• 67457- Mylan Institutional LLC
  • 67457-831- Caspofungin acetate
    • 67457-831-50- 1 VIAL, SINGLE-DOSE in 1 CARTON (67457-831-50) > 10.8 mL in 1 VIAL, SINGLE-DOSE

• 67457- Mylan Institutional LLC
  • 67457-832- Caspofungin acetate
    • 67457-832-70- 1 VIAL, SINGLE-DOSE in 1 CARTON (67457-832-70) > 10.8 mL in 1 VIAL, SINGLE-DOSE

• 68083- Gland Pharma Limited
  • 68083-158- Caspofungin Acetate
    • 68083-158-01- 1 VIAL in 1 CARTON (68083-158-01) > 10 mL in 1 VIAL

• 68083- Gland Pharma Limited
  • 68083-159- Caspofungin Acetate
    • 68083-159-01- 1 VIAL in 1 CARTON (68083-159-01) > 10 mL in 1 VIAL

• 69097- Cipla USA Inc.
  • 69097-365- caspofungin acetate
    • 69097-365-37- 10 mL in 1 VIAL, SINGLE-DOSE (69097-365-37)

• 69097- Cipla USA Inc.
  • 69097-366- caspofungin acetate
    • 69097-366-37- 10 mL in 1 VIAL, SINGLE-DOSE (69097-366-37)

• 70860- Athenex Pharmaceutical Division, LLC.
  • 70860-106- Caspofungin Acetate
    • 70860-106-10- 1 VIAL in 1 CARTON (70860-106-10) > 10.8 mL in 1 VIAL

• 70860- Athenex Pharmaceutical Division, LLC.
  • 70860-107- Caspofungin Acetate
    • 70860-107-10- 1 VIAL in 1 CARTON (70860-107-10) > 10.8 mL in 1 VIAL

• 72266- Fosun Pharma USA Inc.
  • 72266-106- Caspofungin Acetate
    • 72266-106-01- 1 VIAL in 1 CARTON (72266-106-01) > 1 mL in 1 VIAL

• 72266- Fosun Pharma USA Inc.
  • 72266-107- Caspofungin Acetate
    • 72266-107-01- 1 VIAL in 1 CARTON (72266-107-01) > 10 mL in 1 VIAL