Caspofungin

Caspofungin is used for: Candida Infections, Esophageal Candidiasis,

Intravenous Candida Infections Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections Day 1 loading dose: 70 mg IV infused over 1 hr (as a single dose) Maintenance: 50 mg IV qDay infused over 1 hr Continue antifungal therapy for at least 14 days after last positive culture; patients who remain persistently neutropenic may warrant longer course of therapy pending resolution of neutropenia Esophageal Candidiasis Indicated for treatment of esophageal candidiasis 50 mg IV qDay infused over 1 hr, continue for 7-14 days after symptom resolution Loading dose not necessary, has not been studied with this indication May consider suppressive oral therapy in patients with HIV infection because of the risk of oropharyngeal candidiasis relapse Invasive Aspergillosis Indicated for invasive aspergillosis in patients refractory to or intolerant of other therapies (eg, amphotericin B, itraconazole) Day 1 loading dose: 70 mg IV infused over 1 hr (as a single dose) Maintenance: 50 mg IV qDay infused over 1 hr Duration of treatment should be based upon the severity of the underlying disease, recovery from immunosuppression, and clinical response. Febrile Neutropenia Empirical therapy for presumed fungal infections in febrile, neutropenic patients Day 1 loading dose: 70 mg IV infused over 1 hr Maintenance: 50 mg IV qDay infused over 1 hour; if well tolerated but not achieving adequate response, may increase to 70 mg IV qDay Duration of treatment should be based on clinical response; continue empirical therapy until resolution of neutropenia If fungal infection is confirmed, continue therapy for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved Hepatic impairment Mild (Child-Pugh 5-6): No dosage adjustment necessary Moderate (Child-Pugh 7-9): Load 70 mg IV, then 35 mg IV qDay Severe (Child-Pugh >9): Safety and efficacy not established

Candida Infections Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections Dosing based on patient’s body surface area <3 months: Safety and efficacy not established; limited data suggest off-label dose of 25 mg/m²/dose IV once daily >3 months Day 1 loading dose: 70 mg/m² IV infused over 1 hr Maintenance: 50 mg/m² IV qDay infused over 1 hr If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay Not to exceed 70 mg qDay Continue antifungal therapy for at least 14 days after last positive culture; patients who remain persistently neutropenic may warrant longer course of therapy pending resolution of neutropenia Esophageal Candidiasis Dosing based on patient’s body surface area <3 months: Safety and efficacy not established >3 months Day 1 loading dose: 70 mg/m² IV infused over 1 hr Maintenance: 50 mg/m² IV qDay infused over 1 hr If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay Not to exceed 70 mg qDay Continue anti fungal therapy for 7-14 days after symptoms resolution Invasive Aspergillosis Dosing based on patient’s body surface area <3 months: Safety and efficacy not established >3 months Day 1 loading dose: 70 mg/m² IV infused over 1 hr Maintenance: 50 mg/m² IV qDay infused over 1 hr If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay Not to exceed 70 mg qDay Duration of treatment should be based upon the severity of the underlying disease, recovery from immunosuppression, and clinical response Febrile Neutropenia Empirical therapy for presumed fungal infections in febrile, neutropenic patients Dosing based on patient’s body surface area <3 months: safety and efficacy not established >3 months Day 1 loading dose: 70 mg/m² IV infused over 1 hr Maintenance: 50 mg/m² IV qDay infused over 1 hr If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay Not to exceed 70 mg qDay Duration of treatment should be based on clinical response; continue empirical therapy until resolution of neutropenia If fungal infection is confirmed, continue therapy for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved

IV Preparation Reconstitute vial (70 mg for loading dose or 50 mg for daily dose) with 10.5 mL NS, SWI or BWI-may be stored for up to 1 hr at 25°C (or less) Mix gently to obtain clear soln-discard if particulate or discolored Transfer 10 mL of reconstituted solution to 250 mL NS, 1/2NS 1/4NS or LR Use infusion soln within 24 hr if stored at room temp or within 48 hr if refrigerated at 2-8°C If 70 mg vials are not available for preparation of the loading dose, reconstitute two 50 mg vials & transfer 14 mL to 250 mL NS, 1/2NS, 1/4NS or LR For 35 mg, reconstitute a 50 mg vial w/ 10 mL & transfer 7 mL to 250 mL (or 100 mL if medically necessary) infusion soln IV Administration Infuse IV slowly over 1 hr

Hypersensitivity.

Hepatic impairment. Pregnancy and lactation. Monitoring Parameters Monitor hepatic function.

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

Side effects of Caspofungin : 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.

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.