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
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