Caspofungin

Caspofungin

[1 vial $577.27]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Cacidas

ICU INDICATIONS:

  1. invasive or oesophageal candidiasis:
    Treatment of candidemia and the following Candida infections: intra-abdominal abscesses, peritonitis and pleural space infections. Caspofungin acetate has not been studied in endocarditis, osteomyelitis, and meningitis due to Candida.
  2. aspergillus infection:
    Caspofungin is indicated for treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies (i.e., amphotericin B, lipid formulations of amphotericin B, and/or itraconazole); however, it has not been studied as initial therapy for invasive aspergillosis.
  3. empirical therapy for presumed fungal infections in febrile, neutropenic patients.

PRESENTATION AND ADMINISTRATION:

  • IV:
    50mg and 70mg vials of white powder
    Refrigerate at 2-8°C. Do not freeze. Bring vial to room temperature and reconstitute by adding 10.5ml of water for injection. Mix gently until completely dissolved producing a clear solution. Concentrations of reconstituted vials are 7mg/ml (70mg vial) or 5mg/ml (50mg vial). Add required volume of reconstituted solution to 250ml of compatible IV fluid and administer slowly over approximately 1 hour. A reduced volume of 100ml may be used for 50mg or 35mg doses only. Reconstituted solution and diluted infusion solution are stable for 24 hours at or below 25°C
    Compatible with:
    Normal saline, Hartmanns

DOSAGE:

  • IV:
    Loading dose of 70mg followed by 50mg daily
    See also IMPORTANT DRUG INTERACTIONS FOR THE INTENSIVE CARE UNIT as dosage adjustment is required when coadministered with particular medicines.

    Note: dosage adjustment is required in liver failure:
    Patients with mild hepatic insufficiency (Child-Pugh score 5-6) do not need a dosage adjustment. For patients moderate hepatic insufficiency (Child-Pugh score 7-9), caspofungin acetate 35 mg daily is recommended. However, where recommended, a 70-mg loading dose should still be administered on Day 1. There is no clinical experience in patients with severe hepatic insufficiency (Child-Pugh score >9).

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • 70mg/m2 day 1, then 50mg/m2 daily IV

    Note: The safety and efficacy of Caspofungin in the paediatric population is not established.

CLINICAL PHARMACOLOGY:

  • Cancidas is the first of a new class of antifungal drugs (echinocandins) that inhibit the synthesis of an integral component of the fungal cell wall.
  • Caspofungin exhibits in vitro activity against
    Aspergillus species (Aspergillus fumigatus, Aspergillus flavus, and Aspergillus terreus) and Candida species (Candida albicans, Candida glabrata, Candida guilliermondii, Candida krusei, Candida parapsilosis, and Candida tropicalis).
  • Based on available evidence from clinical studies, it appears that Caspofungin is as effective as amphotericin B in empirical therapy of persistent febrile neutropenia and in patients with invasive Candidiasis.

CONTRAINDICATIONS:

  1. hypersensitivity to caspofungin.

WARNINGS

  • Concomitant use of caspofungin acetate with cyclosporine is not recommended unless the potential benefit outweighs the potential risk to the patient due to an increased risk of liver toxicity.

PRECAUTIONS

  • General:
    The efficacy of a 70-mg dose regimen in patients with invasive aspergillosis who are not clinically responding to the 50-mg daily dose is not known. Limited safety data suggest that an increase in dose to 70 mg daily is well tolerated. Laboratory abnormalities in liver function tests have been seen in healthy volunteers and patients treated with caspofungin acetate. In some patients with serious underlying conditions who were receiving multiple concomitant medications along with caspofungin acetate, clinical hepatic abnormalities have also occurred. Isolated cases of significant hepatic dysfunction, hepatitis, or worsening hepatic failure have been reported in patients; a causal relationship to caspofungin acetate has not been established.
  • Laboratory Tests:
    No tests in addition to standard tests are indicated.
  • Drug/Laboratory Test Interactions:
    None known.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Caspofungin with:
    Tacrolimus: Caspofungin acetate reduces the blood levels of tacrolimus. For patients receiving both therapies, standard monitoring of tacrolimus blood concentrations and appropriate tacrolimus dosage adjustments are recommended.
    Cyclosporine: See WARNINGS.
    Rifampicin: A drug-drug interaction study with rifampin in healthy volunteers has shown a 30% decrease in caspofungin trough concentrations. Patients on rifampin should receive 70 mg of caspofungin acetate daily.
    Dexamethasone: Increases clearance of caspofungin; use 70mg daily of caspofungin
    Phenytoin: Increases clearance of caspofungin; use 70mg daily of caspofungin
    Carbamazepine: Increases clearance of caspofungin; use 70mg daily of caspofungin

ADVERSE REACTIONS

  • Body as a whole:
    Chills, Fever, Flushing, Perspiration/diaphoresis
  • Cardiovascular System:
    Hypertension, Tachycardia
  • Gastrointestinal System:
    Abdominal pain, Diarrhoea, Nausea, Vomiting
  • Musculoskeletal System:
    Back pain
  • Respiratory System:
    Dyspnoea, Tachypnoea
  • Nervous System:
    Headache
  • Metabolic:
    Hypokalaemia
  • Skin:
    Rash

Critical Care Drug Manual

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