Caspofungin

DEA Class; Rx

Common Brand Names; Cancidas

  • Antifungals, Systemic; 
  • Antifungals, Echinocandin

IV echinocandin antifungal
Used for aspergillosis, candidemia, esophageal candidiasis, and empiric treatment in febrile neutropenia
Fever and infusion-related reactions common

Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections
Indicated for treatment of esophageal candidiasis
Indicated for invasive aspergillosis in patients refractory to or intolerant of other therapies (eg, amphotericin B, itraconazole)
Empirical therapy for presumed fungal infections in febrile, neutropenic patients
Based on the limited data, an echinocandin drug (eg, anidulafungin, caspofungin, micafungin) is recommended by the CDC as initial therapy for treatment of C auris infections

Hypersensitivity to drug or components of the formulation

  • Varies with condition
  • Anaphylaxis reported during administration of Cancidas
  • Infused vein complications/ phlebitis (20-35%)
  • Fever (6-30%)
  • Diarrhea (6-27%)
  • Shivering (9-23%)
  • Rash (4-23%)
  • Increased serum alkaline phosphatase (9-22%)
  • Hypotension (3-20%)
  • Respiratory failure (2-20%)
  • Incr transaminases (2-18%)
  • Septic shock (11% to 14% )

Anaphylaxis reported, discontinue and administer appropriate treatment; possible histamine-mediated adverse reactions, including rash, facial swelling, angioedema, pruritus, sensation of warmth or bronchospasm

Do not use dextrose diluents

Do not use with cyclosporine (unless benefits outweigh risks)

Not for bolus administration

Can cause abnormalities in hepatic enzyme levels

Cyclosporine may increase AUC of caspofungin by approximately 35%

Hepatic effects: Abnormalities in LFTs and isolated cases of clinically significant hepatic dysfunction, hepatitis, or hepatic failure

Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), some with a fatal outcome, reported; discontinue therapy at first sign or symptom of hypersensitivity reaction and administer appropriate treatment

There are insufficient human data to establish whether there is a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes in pregnant women

There are no data on presence of drug in human milk, effects on breast-fed child, or on milk production

Adults

70 mg/day IV; doses up to 150 mg/day IV have been recommended for cardiovascular infections.

Geriatric

70 mg/day IV; doses up to 150 mg/day IV have been recommended for cardiovascular infections.

Adolescents

70 mg/m2/day IV, not to exceed 70 mg IV.

Children

70 mg/m2/day IV, not to exceed 70 mg IV.

Infants

>= 3 months: 70 mg/m2/day IV, not to exceed 70 mg IV.
< 3 months: Safety and efficacy have not been established; however, doses up to 25 mg/m2/day IV are used off-label.

Neonates

Safety and efficacy have not been established; however, doses up to 25 mg/m2/day IV are used off-label.

Caspofungin acetate

powder for injection

  • 50mg/vial
  • 70mg/vial

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