CASPOFUNGIN

CASPOFUNGIN
(cas-po-fun'gin)
Cancidas
Classifications: antibiotic; echinocandin antifungal;
Therapeutic: antifungal antibiotic

Pregnancy Category: C

Availability

50 mg and 70 mg powder for injection

Action

Caspofungin is an antifungal agent that inhibits the synthesis of an integral component of the fungal cell wall of susceptible species.

Therapeutic Effect

Interferes with reproduction and growth of susceptible fungi.

Uses

Treatment of invasive aspergillosis in those refractory to or intolerant of other antifungal therapies; empirical therapy for presumed fungal infection with febrile neutropenia; treatment of candidemia and intra-abdominal abscesses, peritonitis, and pleural space infections due to Candida.

Unlabeled Uses

Treatment of esophageal candidiasis with or without oropharyngeal candidiasis (thrush).

Contraindications

Hypersensitivity to any component of this product; mannitol; pregnancy (category C); not studied in patients with ESRF, or children <18 y.

Cautious Use

Patients with moderate hepatic insufficiency; cholestasis; concomitant use of cyclosporine; lactation.

Route & Dosage

Invasive Aspergillosis, Empirical Therapy, Candida
Adult: IV 70 mg on day 1, then 50 mg qd thereafter

Administration

Intravenous
  • Allow vial to come to room temperature.
  • A loading dose is usually administered on day 1 followed on subsequent days by a maintenance dose.

PREPARE: IV Infusion: Reconstitute a 50 mg or 70 mg vial with 10.5 mL of NS, sterile water for injection, or bacteriostatic water for injection to yield 5 mg/mL and 7 mg/mL, respectively. Mix gently until clear. Withdraw the required dose of reconstituted solution and add to 250 mL of NS, ?NS, or 0.225% NaCl, or RL. DO NOT use diluents or IV solutions containing dextrose.  

ADMINISTER: IV Infusion: Give slowly over at least 1 h. Do not co-infuse with any other medication.  

INCOMPATIBILITIES Solution/additive: Any dextrose-containing solution. Do not mix or co-infuse with any other medications.

  • Store IV solution for up to 24 h at 25° C (77° F) or below or 48 h at 2°–8° C (36°–46° F). Reconstituted solution should be stored at ≤25° C (≤77° F) for 1 h prior to preparing the IV solution for infusion.

Adverse Effects (≥1%)

Body as a Whole: Anaphylaxis, chills, injection site reaction, sensation of warmth. CNS: Headache. CV: Sinus tachycardia. GI: Nausea, vomiting, diarrhea, abdominal pain. Hematologic/Lymphatic: Phlebitis, thrombophlebitis, vasculitis, anemia. Hepatic: Elevated liver enzymes. Metabolic: Anorexia, hypokalemia. Musculoskeletal: Pain, myalgia. Respiratory: Acute respiratory distress syndrome, dyspnea. Skin: Rash, facial swelling, pruritus.

Interactions

Drug: Cyclosporine increases overall systematic exposure to caspofungin; inducers of drug clearance or mixed inducer/inhibitors (e.g., carbamazepine, dexamethasone, efavirenz, nelfinavir, nevirapine, phenytoin, rifampin) can decrease caspofungin levels; caspofungin decreases the overall systematic exposure to tacrolimus.

Pharmacokinetics

Distribution: 97% protein bound. Metabolism: Liver and plasma to inactive metabolites. Elimination: Both in urine and feces. Half-Life: 9–11 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of hypersensitivity during IV infusion; frequently monitor IV site for thrombophlebitis.
  • Monitor for and report S&S of fluid retention (e.g., weight gain, swelling, peripheral edema), especially with known cardiovascular disease.
  • Lab tests: Baseline and periodic LFTs; periodic kidney function tests, serum electrolytes, and CBC with differential, platelet count.
  • Monitor blood levels of tacrolimus with concurrent therapy.

Patient & Family Education

  • Report immediately any of the following: facial swelling, wheezing, difficulty breathing or swallowing, tightness in chest, rash, hives, itching, or sensation of warmth.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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