caspofungin, Cancidas

 Indications

Invasive aspergillosis refractory to, or intolerant of,

other therapies. Candidemia and associated serious infections

(intra-abdominal abscesses, peritonitis, pleural

space infections). Esophageal candidiasis. Suspected

fungal infections in febrile neutropenic patients.

Action

Inhibits the synthesis of (1, 3)-D-glucan, a necessary

component of the fungal cell wall. Therapeutic Effects:

Death of susceptible fungi.

Pharmacokinetics

Absorption: IV administration results in complete

bioavailability.

Distribution: Widely distributed to tissues.

Protein Binding: 97%.

Metabolism and Excretion: Slowly and extensively

metabolized; 1.5% excreted unchanged in

urine.

Half-life: Polyphasic: phase—9–11 hr; 

phase—40–50 hr.

TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION

IV unknown end of infusion

24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Concurrent

use with cyclosporine.

Use Cautiously in: Moderate hepatic impairment

(pmaintenance dose recommended).

Adverse Reactions/Side Effects

CNS: headache, chills. GI: diarrhea,qliver enzymes,

nausea, vomiting. Resp: bronchospasm. GU:qserum

creatinine. Derm: STEVENS-JOHNSON SYNDROME, TOXIC

EPIDERMAL NECROLYSIS, flushing, pruritis, rash. Local:

venous irritation at injection site. Misc: allergic reactions

including ANAPHYLAXIS, ANGIOEDEMA, fever. 

Interactions

Drug-Drug: Concurrent use with cyclosporine is

not recommended due toqrisk of hepatic toxicity. May

pblood levels and effects of tacrolimus. Blood levels

and effectiveness may bepby rifampin; maintenance

dose should beqto 70 mg (in patients with normal

liver function). Blood levels and effectiveness also may

bepby efavirenz, nelfinavir, nevirapine, phenytoin,

dexamethasone, or carbamazepine; anqin

the maintenance dose to 70 mg should be considered

in patients who are not clinically responding.

Route/Dosage

IV (Adults): 70 mg initially followed by 50 mg daily,

duration determined by clinical situation and response;

Esophageal candidiasis—50 mg daily, duration determined

by clinical situation and response.

IV (Children 3mo): 70 mg/m2 (max: 70 mg) initially

followed by 50 mg/m2 daily (max: 70 mg/day),

duration determined by clinical situation and response.

IV (Infants 1 to 3 mo and Neonates): 25 mg/m2/

dose once daily.

Hepatic Impairment

IV (Adults): Moderate hepatic impairment—70 mg

initially followed by 35 mg daily, duration determined

by clinical situation and response.

Availability (generic available)

Powder for injection: 50 mg/vial, 70 mg/vial.