Caspofungin

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/m ² 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.
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 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.

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.
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 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.

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 1st +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.
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 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.

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.
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 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.

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

Hypersensitivity.

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

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.

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

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.
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).

Intravenous: Store between 2-8°C.

Antifungals

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