Caspofungin: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the Indonesia prescribing information.

Generic Medicine Info

Indications and Dosage

Intravenous
Invasive candidiasis

Adult: 70 mg on 1st day, followed by 50 mg (70 mg in patient >80 kg) once daily thereafter. Doses are given by slow infusion over approx 1 hr. Duration of treatment: Based on clinical and microbiological response; continued for 14 days after the last +ve blood culture and resolution of symptoms.
Child: 12 mth to 17 yr 70 mg/m² on 1st day, followed by 50 mg/m² once daily thereafter. Dose are given by slow infusion over approx 1 hr. If clinical response is inadequate, may increase to 70 mg/m² once daily. Max: 70 mg daily.

Intravenous
Empiric therapy for febrile neutropenic patients

Adult: 70 mg on 1st day, followed by 50 mg (70 mg in patient >80 kg) once daily thereafter. Doses are given by slow infusion over approx 1 hr. Duration of treatment: Based on clinical response; continued for at least 14 days total and for at least 7 days after both neutropenia and clinical symptoms are resolved.
Child: 12 mth to 17 yr 70 mg/m² on 1st day, followed by 50 mg/m² once daily thereafter. Dose are given by slow infusion over approx 1 hr. If clinical response is inadequate, may increase to 70 mg/ m² once daily. Max: 70 mg daily.

Intravenous
Invasive aspergillosis

Adult: 70 mg on 1st day, followed by 50 mg (70 mg in patient >80 kg) once daily thereafter. Doses are given by slow infusion over approx 1 hr. Duration of treatment: Based on severity of disease, recovery from immunosuppression, and clinical response; continued for at least 7 days after resolution of symptoms.
Child: 12 mth to 17 yr 70 mg/m² on 1st day, followed by 50 mg/m² once daily thereafter. Dose are given by slow infusion over approx 1 hr. If clinical response is inadequate, may increase to 70 mg/m² once daily. Max: 70 mg daily.

Intravenous
Oesophageal candidiasis

Adult: 50 mg (70 mg in patient >80 kg) once daily by slow infusion over approx 1 hr, continued for 7-14 days after symptom resolution.
Child: 12 mth to 17 yr 70 mg/m² on 1st day, followed by 50 mg/m² once daily thereafter. Dose are given by slow infusion over approx 1 hr. If clinical response is inadequate, may increase to 70 mg/m² once daily. Max: 70 mg daily.

Special Patient Group

Patient taking CYP enzyme inducers (e.g. efavirenz, nevirapine, phenytoin, dexamethasone, carbamazepine, rifampicin): 70 mg once daily by slow infusion over approx 1 hr.

Hepatic Impairment

Moderate (Child-Pugh score 7 to 9): 70 mg on 1st day, followed by 35 mg once daily.

Reconstitution

Add 10.8 mL of NaCl 0.9%, sterile water for inj, or bacteriostatic water for inj to a vial labelled as containing 50 mg or 70 mg to provide a soln containing 5 mg/mL or 7 mg/mL, respectively. Transfer the appropriate volume (equivalent to the indicated loading or maintenance dose) of the reconstituted soln to an IV bag/bottle containing 250 mL NaCl 0.9%, 0.45%, or 0.225% or lactated ringers inj. Alternatively, the appropriate volume of reconstituted soln may be added to a reduced volume of NaCl 0.9%, 0.45%, or 0.225% or lactated ringers inj, not to exceed a final concentration of 0.5 mg/mL.

Incompatibility

Incompatible w/ dextrose-containing diluents. Y-site admin: Incompatible w/ amphotericin B, ampicillin, cefazolin, cefepime, ceftazidime, ceftriaxone, clindamycin, cytarabine, ertapenem, furosemide, heparin, methylprednisolone, nafcillin, piperacillin/tazobactam, K phosphate, sulfamethoxazole/trimethoprim.

Contraindications

Hypersensitivity.

Special Precautions

Hepatic impairment. Pregnancy and lactation.

Adverse Reactions

Diarrhoea, nausea, vomiting, flushing, headache, fever, chills, arthralgia, phlebitis, tachycardia, rash, erythema, facial swelling, pruritus, hyperhidrosis, warm sensation, dyspnoea, bronchospasm; hyperhidrosis, hypokalaemia, increased liver enzymes and alkaline phosphatase, decreased RBC and WBC levels; pulmonary oedema, adult resp distress syndrome (ARDS), radiographic infiltrates (invasive aspergillosis).
Potentially Fatal: Anaphylaxis, severe toxic epidermal necrolysis, Stevens-Johnson syndrome.

Pregnancy Category (US FDA)

IV/Parenteral: C

Monitoring Parameters

Monitor hepatic function.

Drug Interactions

Reduced plasma concentration w/ rifampicin and other CYP enzyme inducers. May increase hepatic enzymes w/ ciclosporin. May decrease blood concentration of tacrolimus.

Action

Description:
Mechanism of Action: Caspofungin, a semisynthetic echinocandin antifungal, shows activity against Aspergillus and Candida species. It inhibits the synthesis of β-1,3-D-glucan, an essential component of the fungal cell wall that is not present in mammalian cells.
Pharmacokinetics:
Distribution: Distributed into the liver, lung, spleen, and GI tract. Plasma protein binding: Approx 97%, mainly to albumin.
Metabolism: Slowly metabolised in the liver via hydrolysis and N-acetylation. Undergoes spontaneous chemical degradation into an open-ring peptide.
Excretion: Via urine (41%, primarily as metabolites, approx 1% as unchanged drug) and faeces (35%, primarily as metabolites). Elimination half-life: Immediate (α-phase); 9-11 hr (β-phase); 40-50 hr (γ-phase).

Chemical Structure

Storage

Store between 2-8°C.

MIMS Class

Antifungals

ATC Classification

J02AX04 - caspofungin ; Belongs to the class of other systemic antimycotics.

References

Anon. Caspofungin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 21/11/2016.

Buckingham R (ed). Caspofungin Acetate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 21/11/2016.

Cancidas Injection, Powder, Lyophilized, for Solution (Merck Sharp & Dohme Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 21/11/2016.

Joint Formulary Committee. Caspofungin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 21/11/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Caspofungin Acetate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 21/11/2016.

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