caspofungin

kas-po-FUN-gin

Therapeutic Classification: antifungals

Pharmacologic Classification: echinocandins

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.

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

Therapeutic effects:

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: βphase: 9–11 hr; γphase: 40–50 hr.

ROUTE	ONSET	PEAK	DURATION
IV	unknown	end of infusion	24 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 (TEN)

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; consider ↑ maintenance dose to 70 mg/day 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.

Hepatic Impairment

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

(Generic available)

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

Assess patient for signs and symptoms of fungal infections before and periodically during therapy.
Assess for skin rash frequently during therapy. Discontinue at first sign of rash; may be life-threatening. SJS and TEN may develop. Treat symptomatically; may recur once treatment is stopped.
Monitor for signs and symptoms of hypersensitivity reactions, including anaphylaxis (rash, dyspnea, stridor, facial swelling, angioedema, pruritus, sensation of warmth, bronchospasm) during therapy. If hypersensitivity reaction occurs, stop infusion and implement supportive medical management as needed.

Lab Test Considerations:

May ↑ serum alkaline phosphatase, serum creatinine, AST, ALT, eosinophils, and urine protein and RBCs. May ↓ serum potassium, hemoglobin, hematocrit, and WBC count.

IV Administration:

Intermittent Infusion: Allow refrigerated vial to reach room temperature. Reconstitution: 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. 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. Reconstituted solution is stable for 1 hr at room temperature. Concentration: 5 mg/mL (50 mg vial); 7 mg/mL (70 mg vial). Diluent: Further dilute appropriate volume of reconstituted solution with 0.9% NaCl, 0.45% NaCl, 0.225% NaCl, or LR. Infusion is stable for 24 hr at room temperature or 48 hr if refrigerated. Concentration: Not to exceed 0.5 mg/mL.
Rate: Infuse over 1 hr.
Y-Site Compatibility:
- alemtuzumab
- allopurinol
- 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
- 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
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- aminocaproic acid
- 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 phosphates
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- trimethoprim/sulfamethoxazole
Solution Incompatibility:
- Solutions containing dextrose

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Inform patient about the need for routine lab monitoring during therapy.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
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 women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Death of susceptible fungi.

~~Cancidas~~

NDC Code

0006- Merck Sharp & Dohme LLC
- 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 & Dohme LLC
- 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)

14474- Sai Life Sciences Limited
- 14474-037-
  - 14474-037-01- 5 kg in 1 BAG (14474-037-01)

25021- Sagent Pharmaceuticals
- 25021-194- Caspofungin Acetate
  - 25021-194-10- 1 VIAL in 1 CARTON (25021-194-10) / 10 mL in 1 VIAL

25021- Sagent Pharmaceuticals
- 25021-195- Caspofungin Acetate
  - 25021-195-10- 1 VIAL in 1 CARTON (25021-195-10) / 10 mL in 1 VIAL

52076- Chunghwa Chemical Synthesis & Biotech. Ltd
- 52076-6230-
  - 52076-6230-1- 50 kg in 1 DRUM (52076-6230-1)

57884- Jiangsu Hengrui Pharmaceuticals Co., Ltd.
- 57884-0030-
  - 57884-0030-1- 500 g in 1 PACKAGE (57884-0030-1)

59923- Areva Pharmaceuticals
- 59923-613- CASPOFUNGIN ACETATE
  59923-613-70- 1 VIAL, SINGLE-DOSE in 1 CARTON (59923-613-70) / 10.8 mL in 1 VIAL, SINGLE-DOSE

59923- Areva Pharmaceuticals
- 59923-614- CASPOFUNGIN ACETATE
  - 59923-614-50- 1 VIAL, SINGLE-DOSE in 1 CARTON (59923-614-50) / 10.8 mL in 1 VIAL, SINGLE-DOSE

62227- BrightGene Bio-Medical Technology Co., Ltd.
- 62227-022-
  - 62227-022-01- 1 kg in 1 BAG (62227-022-01)

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)

65897- Hangzhou Zhongmei Huadong Pharmaceutical Co., Ltd.
- 65897-0002- CASPOFUNGIN ACETATE
  - 65897-0002-1- 1 VIAL, SINGLE-DOSE in 1 CARTON (65897-0002-1) / 10.8 mL in 1 VIAL, SINGLE-DOSE

65897- Hangzhou Zhongmei Huadong Pharmaceutical Co., Ltd.
- 65897-0004- CASPOFUNGIN ACETATE
  - 65897-0004-1- 1 VIAL, SINGLE-USE in 1 CARTON (65897-0004-1) / 10.8 mL in 1 VIAL, SINGLE-USE

65977- HETERO DRUGS LIMITED
- 65977-0164-
  - 65977-0164-1- 1 kg in 1 DRUM (65977-0164-1)

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

69766- MSN Life Sciences Private Limited
- 69766-064-
  - 69766-064-01- 50 kg in 1 DRUM (69766-064-01)

69806- Merck Sharp & Dohme Corp.
- 69806-0092-
  69806-0092-0- 1 CAN in 1 BOX (69806-0092-0) / 5.7 kg in 1 CAN

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

72611- Almaject, Inc.
- 72611-700- caspofungin acetate
  - 72611-700-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (72611-700-01) / 10.8 mL in 1 VIAL, SINGLE-DOSE

84517- Zhejiang Wild Wind Pharmaceutical Co.,Ltd.
- 84517-053-
  - 84517-053-01- 250 g in 1 BAG (84517-053-01)

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