service provider [10:<12 years); Terminal: 40 to 50 hours; beta phase half-life is 32% to 43% lower in pediatric patients than in adult patients Protein Binding ~97% to albumin Special Populations: Renal Function Impairment AUC is increased 30% to 49% in patients with CrCl 49 mL/minute after administration of a single 70 mg dose. No effect on caspofungin concentrations was seen in patients with mild to end-stage renal impairment after administration of multiple daily doses. Special Populations: Hepatic Function Impairment AUC is increased by ~55% in patients with mild hepatic impairment (Child-Pugh class A) and by 76% in patients with moderate hepatic impairment (Child-Pugh class B). Special Populations: Elderly AUC is increased by ~28%. Special Populations: Gender AUC in women was ~22% higher than in men after repeat dosing. Use: Labeled Indications Aspergillosis, invasive: Treatment of invasive aspergillosis in patients 3 months of age who are refractory to or intolerant of other therapies (eg, amphotericin B, lipid formulations of amphotericin B, itraconazole). Limitations of use: Has not been studied as initial therapy for invasive aspergillosis. Candidemia and other Candida infections: Treatment of candidemia and the following candida infections in patients 3 months of age: Intra-abdominal abscesses, peritonitis, and pleural space infections. Limitations of use: Has not been studied in endocarditis, osteomyelitis, and meningitis due to Candida . Candidiasis, esophageal: Treatment of esophageal candidiasis in patients 3 months of age. Limitations of use: Not approved for the treatment of oropharyngeal candidiasis (OPC). Fungal infections, empiric therapy (neutropenic patients): Empiric therapy for presumed fungal infections in febrile, neutropenic patients 3 months of age. Off Label Uses Candida infection, prophylaxis in neutropenic cancer patients at substantial risk Based on the Infectious Diseases Society of America (IDSA) guidelines for the use of antimicrobial agents in neutropenic patients with cancer , caspofungin is effective and recommended as an alternate agent in the prophylaxis against Candida infection in neutropenic cancer patients with substantial risk (eg, allogeneic transplant or undergoing induction therapy for acute leukemia). Candidiasis, chronic disseminated (hepatosplenic) Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis , caspofungin is an effective and recommended treatment for patients with chronic disseminated (hepatosplenic) candidiasis. Candidiasis, empiric therapy (non-neutropenic ICU patients) Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis , caspofungin is an effective and recommended agent for empiric therapy of suspected invasive candidiasis in non-neutropenic patients in the ICU. Candidiasis, esophageal, in HIV-infected patients (adolescents and adults) Based on the US Department of Health and Human Services (HHS) Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents , caspofungin is an effective and recommended alternative agent for the treatment of esophageal candidiasis in adolescent and adult HIV-infected patients. Candidiasis, intravascular infections Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis , caspofungin is an effective and recommended treatment for patients with Candida intravascular infections, including patients with endocarditis (native or prosthetic valve), infections of implantable cardiac devices (pacemaker, implantable cardiac defibrillator), and Candida suppurative thrombophlebitis. Candidiasis, oropharyngeal (refractory disease) Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis , caspofungin may be considered as an alternative for patients with oropharyngeal candidiasis refractory to other antifungals. Candidiasis, osteoarticular infections Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis , caspofungin is an effective and recommended treatment for patients with Candida osteoarticular infections, including Candida osteomyelitis and Candida septic arthritis. Candidiasis, prophylaxis against invasive candidiasis (high-risk ICU patients in units with a high rate of invasive candidiasis) Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis , caspofungin may be considered as an alternative agent for prophylaxis against invasive candidiasis in high-risk patients in adult ICUs with a high rate of invasive candidiasis (> 5%). Contraindications Hypersensitivity to caspofungin or any component of the formulation Documentation of allergenic cross-reactivity for echinocandin antifungals is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty. Dosing: Adult Note: Duration of caspofungin treatment should be determined by patient status and clinical response. Aspergillosis, invasive (salvage therapy): IV: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg once daily. Duration of therapy should be a minimum of 6 to 12 weeks and depends on site of infection, extent of disease, and level/duration of immunosuppression (IDSA [Patterson 2016]). Candidemia and other Candida infections: IV: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg once daily; generally continue for at least 14 days after the last positive culture or longer if neutropenia warrants. Higher doses (150 mg once daily infused over ~2 hours) compared to the standard adult dosing regimen (50 mg once daily) have not demonstrated additional benefit or toxicity in patients with invasive candidiasis (Betts 2009). Note: IDSA Candidiasis guidelines recommend transition to fluconazole (usually after 5 to 7 days in non-neutropenic patients) in clinically stable patients with fluconazole-susceptible isolates and negative repeat cultures (IDSA [Pappas 2016]). Candida infection, prophylaxis in neutropenic cancer patients at substantial risk (off-label use): IV: 50 mg once daily (Mattiuzzi 2006). Candidiasis, chronic disseminated (hepatosplenic) (off-label use): IV: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg daily for several weeks, followed by oral fluconazole therapy (IDSA [Pappas 2016]) Candidiasis, empiric therapy (non-neutropenic ICU patients) (off-label use): IV: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg once daily. Consider discontinuing after 4 to 5 days in patients with no clinical response; continue treatment for 2 weeks in patients who improve on antifungal therapy (IDSA [Pappas 2016]). Candidiasis, esophageal: IV: Manufacturer s labeling: 50 mg once daily; continue for 7 to 14 days after symptom resolution. Note: The majority of patients studied for this indication also had oropharyngeal involvement. Alternate recommendations: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg daily; may transition to oral fluconazole therapy once oral intake tolerable. In patients with fluconazole-refractory disease, continue caspofungin for 14 to 21 days (Pappas [IDSA 2016]) Candidiasis, esophageal, in HIV-infected patients (alternative agent) (off-label use): IV: 50 mg once daily; continue for 14 to 21 days. Note: A higher rate of relapse has been reported with echinocandins than with fluconazole (HHS [OI adult 2017]). Candidiasis, intravascular infections (native or prosthetic valve endocarditis, infection of implantable cardiac devices, suppurative thrombophlebitis) (off-label use): IV: 150 mg daily. For native or prosthetic valve endocarditis, therapy should continue for at least 6 weeks after valve replacement surgery (longer durations in patients with abscesses or other complications); for patients with implantable cardiac devices, therapy should continue for 4 to 6 weeks after surgery (4 weeks for infections limited to generator pockets and at least 6 weeks for infections involving the wires); for suppurative thrombophlebitis, continue for at least 2 weeks after candidemia has cleared. Note: Step-down to fluconazole therapy is recommended in clinically stable patients with fluconazole-susceptible isolates and negative repeat cultures (IDSA [Pappas 2016]). Candidiasis, osteoarticular infections (osteomyelitis or septic arthritis) (alternative therapy) (off-label use): IV: 50 to 70 mg daily for at least 14 days, followed by fluconazole (IDSA [Pappas 2016]) Candidiasis, prophylaxis against invasive candidiasis (high-risk ICU patients in units with a high rate of invasive candidiasis) (alternative therapy; off-label use): IV: Loading dose: 70 mg on day 1, then 50 mg daily (IDSA [Pappas 2016]) Candidiasis, oropharyngeal (refractory disease) (alternative therapy) (off-label use): IV: Initial dose: 70 mg on day 1; subsequent doses: 50 mg once daily (Pappas [IDSA 2016]) Fungal infections, empiric therapy (neutropenic patients): IV: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg once daily; continue until resolution of neutropenia; if fungal infection confirmed, continue for a minimum of 14 days (continue for at least 7 days after resolution of both neutropenia and clinical symptoms); if clinical response inadequate, may increase up to 70 mg once daily if tolerated Dosage adjustment with concomitant use of an enzyme inducer: Patients receiving rifampin: 70 mg caspofungin once daily Patients receiving carbamazepine, dexamethasone, efavirenz, nevirapine, or phenytoin (and possibly other enzyme inducers): May require an increased dose of caspofungin 70 mg once daily. Dosing: Geriatric Refer to adult dosing. Dosing: Pediatric Aspergillosis (invasive), candidemia, esophageal candidiasis, and fungal infections (empiric therapy, neutropenic patients): Infants 3 months, Children, and Adolescents 17 years: IV: Initial dose: 70 mg/m 2 on day 1, subsequent dosing: 50 mg/m 2 once daily, if clinical response inadequate, may increase to 70 mg/m 2 once daily if tolerated (maximum daily dose, loading or maintenance: 70 mg). Duration of caspofungin treatment should be determined by patient status and clinical response; refer to adult dosing for indication-specific recommended durations. Candidiasis, esophageal, in HIV-infected patients (alternative agent) (off-label use): Adolescents: IV: Refer to adult dosing. Dosage adjustment with concomitant use of an enzyme inducer: Patients receiving rifampin: 70 mg/m 2 once daily (maximum daily dose: 70 mg/day) Patients receiving carbamazepine, dexamethasone, efavirenz, nevirapine, or phenytoin (and possibly other enzyme inducers): Consider 70 mg/m 2 once daily (maximum daily dose: 70 mg/day) Dosing: Renal Impairment No dosage adjustment necessary. End-stage renal disease (ESRD) requiring dialysis: Poorly dialyzed; no supplemental dose or dosage adjustment necessary in patients on intermittent hemodialysis (IHD). No supplemental dose or dosage adjustment needed in peritoneal dialysis or continuous renal replacement therapy (eg, CVVHD) (Aronoff 2007; Heintz 2009). Dosing: Hepatic Impairment Adults: Mild impairment (Child-Pugh class A): No dosage adjustment necessary. Moderate impairment (Child-Pugh class B): 70 mg on day 1 (where recommended), followed by 35 mg once daily Severe impairment (Child-Pugh class C): There are no dosage adjustments provided in the labeling (has not been studied). Children: Mild to severe impairment (Child-Pugh classes A, B, or C): There are no dosage adjustments provided in the manufacturer's labeling (has not been studied). Reconstitution Bring intact vial to room temperature. Reconstitute vials using 10.8 mL NS for injection, SWFI, or bacteriostatic water for injection, resulting in a concentration of 5 mg/mL for the 50 mg vial, and 7 mg/mL for the 70 mg vial (vials contain overfill). Mix gently to dissolve until clear solution is formed; do not use if cloudy or contains particles. Solution should be further diluted with 0.9%, 0.45%, or 0.225% sodium chloride or LR (do not exceed final concentration of 0.5 mg/mL). Administration Infuse slowly, over ~1 hour. Do not administer by IV bolus. Storage Store intact vials at 2 C to 8 C (36 F to 46 F). Reconstituted solution may be stored at 25 C ( 77 F) for up to 1 hour prior to preparation of infusion solution. Solutions diluted in NS, 1 / 2 NS, 1 / 4 NS, or LR for infusion should be used within 24 hours when stored at 25 C ( 77 F) or within 48 hours when stored at 2 C to 8 C (36 F to 46 F). Drug Interactions CycloSPORINE (Systemic): May enhance the adverse/toxic effect of Caspofungin. CycloSPORINE (Systemic) may increase the serum concentration of Caspofungin. Management: Weigh potential benefits of caspofungin against a possible elevated risk of hepatotoxicity. Monitor liver function and re-evaluate treatment in patients with abnormal values. Mild transaminase elevations may occur relatively commonly. Consider therapy modification Inducers of Drug Clearance: May decrease the serum concentration of Caspofungin. Management: Consider using an increased caspofungin dose of 70 mg daily in adults (or 70 mg/m 2 , up to a maximum of 70 mg, daily in pediatric patients) when coadministered with known inducers of drug clearance. Consider therapy modification RifAMPin: May decrease the serum concentration of Caspofungin. Management: Caspofungin prescribing information recommends using a dose of 70 mg daily in adults (or 70 mg/m 2 , up to a maximum of 70 mg, daily in pediatric patients) who are also receiving rifampin. Consider therapy modification Saccharomyces boulardii: Antifungal Agents (Systemic, Oral) may diminish the therapeutic effect of Saccharomyces boulardii. Avoid combination Tacrolimus (Systemic): Caspofungin may decrease the serum concentration of Tacrolimus (Systemic). Monitor therapy Adverse Reactions >10%: Cardiovascular: Hypotension (adults: 3% to 20%; infants, children, and adolescents: 9%), peripheral edema (adults: 6% to 11%), tachycardia (7% to 11%) Central nervous system: Chills (adults: 9% to 23%; infants, children, and adolescents: 13%), headache (9% to 15%) Dermatologic: Skin rash (4% to 23%) Gastrointestinal: Diarrhea (adults: 6% to 27%; infants, children, and adolescents: 7%), vomiting (6% to 17%), nausea (adults: 5% to 15%; infants, children, and adolescents: 4%) Hematologic & oncologic: Decreased hemoglobin (adults: 18% to 21%), decreased hematocrit (adults: 13% to 18%), decreased white blood cell count (adults: 12%), anemia (adults: 11%) Hepatic: Increased serum alkaline phosphatase (adults: 9% to 22%), increased serum ALT (adults: 4% to 18%; infants, children, and adolescents: 5%), increased serum AST (adults: 6% to 16%; infants, children, and adolescents: 2%), increased serum bilirubin (adults: 5% to 13%) Local: Localized phlebitis (adults: 18%) Renal: Increased serum creatinine (adults: 3% to 11%) Respiratory: Respiratory failure (adults: 2% to 20%), cough (adults: 6% to 11%), pneumonia (adults: 4% to 11%) Miscellaneous: Infusion related reaction (20% to 35%), fever (6% to 30%), septic shock (adults: 11% to 14%) 1% to 10%: Cardiovascular: Hypertension (5% to 9%), atrial fibrillation ( <5%), bradycardia (> <5%), cardiac arrhythmia (> <5%), edema (> <5%), flushing (> <5%), myocardial infarction (> <5%) Central nervous system: Anxiety (> <5%), confusion (> <5%), depression (> <5%), dizziness (> <5%), drowsiness (> <5%), fatigue (> <5%), insomnia (> <5%), seizure (> <5%) Dermatologic: Erythema (5% to 9%), pruritus (infants, children, and adolescents: 6%), skin lesion (> <5%), urticaria (> <5%), decubitus ulcer (adults: 3% to 5%) Endocrine & metabolic: Hypomagnesemia (adults: 7%), hyperglycemia (adults: 6%), hypokalemia (5% to 6%), hypercalcemia (> <5%), hypervolemia (> <5%) Gastrointestinal: Abdominal pain (4% to 9%), mucosal inflammation (4% to 6%), abdominal distention (> <5%), anorexia (> <5%), constipation (> <5%), decreased appetite (> <5%), dyspepsia (> <5%), upper abdominal pain (> <5%) Genitourinary: Urinary tract infection (> <5%), nephrotoxicity (adults: 3%; serum creatinine 2 x baseline value or 1 mg/dL in patients with serum creatinine above ULN range) Hematologic & oncologic: Blood coagulation disorder (> <5%), febrile neutropenia (> <5%), neutropenia (> <5%), petechia (> <5%), thrombocytopenia (> <5%) Hepatic: Decreased serum albumin (adults: 7%), hepatic failure (> <5%), hepatomegaly (> <5%), hepatotoxicity (> <5%), hyperbilirubinemia (> <5%), jaundice (> <5%) Infection: Sepsis (adults: 5% to 7%), bacteremia (> <5%) Local: Catheter infection (infants, children, and adolescents: 9%), infusion site reaction (> <5%; pain/pruritus/swelling) Neuromuscular & skeletal: Arthralgia (> <5%), back pain (> <5%), limb pain (> <5%), tremor (> <5%), weakness (> <5%) Renal: Hematuria (adults: 10%), increased blood urea nitrogen (adults: 4% to 9%), renal failure (> <5%) Respiratory: Dyspnea (adults: 9%), pleural effusion (adults: 9%), respiratory distress (adults: 8%), rales (adults: 7%), epistaxis (> <5%), hypoxia (> <5%), tachypnea (> <5%)> <1% (Limited to important or life-threatening): Anaphylaxis, erythema multiforme, hepatitis, histamine release (including facial swelling, bronchospasm, sensation of warmth), increased gamma-glutamyl transferase, pancreatitis, Stevens-Johnson syndrome, swelling, toxic epidermal necrolysis Warnings/Precautions Concerns related to adverse effects: Hepatic effects: Increased transaminases and rare cases of clinically significant hepatic dysfunction (including failure and hepatitis) have been reported in pediatric and adult patients. Monitor liver function tests during therapy; if tests become abnormal or worsen, consider discontinuation. Hypersensitivity: Anaphylaxis, other hypersensitivity reactions, histamine-related reactions (eg, angioedema, facial swelling, bronchospasm, rash, sensation of warmth), and cases of Stevens-Johnson syndrome and toxic epidermal necrolysis (some fatal) have been reported. Discontinue if a hypersensitivity reaction occurs. Administer supportive treatment if needed. Disease-related concerns: Hepatic impairment: Use with caution in patients with hepatic impairment. Dosage reduction required in adults with moderate hepatic impairment (Child-Pugh class B); safety and efficacy have not been established in children with any degree of hepatic impairment and adults with severe hepatic impairment (Child-Pugh class C). Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Monitoring Parameters Liver function; anaphylaxis, skin rash, or histamine-related reactions (eg, facial swelling, bronchospasm, sensation of warmth) Pregnancy Risk Factor C Pregnancy Considerations Adverse events have been observed in animal reproduction studies. When treatment of invasive Aspergillus or Candida infections is needed during pregnancy, other agents are preferred (HHS [adult] 2017; IDSA [Pappas 2016]). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience abdominal pain, nausea, vomiting, or diarrhea. Have patient report immediately to prescriber signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of low potassium (muscle pain or weakness, muscle cramps, or an abnormal heartbeat), signs of low magnesium (mood changes; muscle pain or weakness; muscle cramps or spasms; seizures; tremors; lack of appetite; severe nausea or vomiting; or an abnormal heartbeat), signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, polyuria, flushing, fast breathing, or breath that smells like fruit), severe headache, severe dizziness, passing out, vision changes, fast breathing, feeling of warmth, flushing, tachycardia, cough, severe loss of strength and energy, chills, injection site pain or irritation, shortness of breath, swelling of arms or legs, signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes), or flushing (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about caspofungin Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Support Group Pricing & Coupons En Español 0 Reviews Add your own review/rating Drug class: echinocandins Consumer resources Caspofungin Caspofungin Intravenous (Advanced Reading) Professional resources Caspofungin Acetate (AHFS Monograph) Caspofungin Acetate Injection (FDA) Other brands: Cancidas Related treatment guides Esophageal Candidiasis Aspergillosis, Invasive Candidemia Febrile Neutropenia> ]} Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Caspofungin Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Drug Class Echinocandins Related Drugs echinocandins micafungin , Mycamine , Cancidas , anidulafungin , Eraxis Aspergillosis, Invasive itraconazole , voriconazole , amphotericin b , Sporanox , Cresemba , posaconazole , More... Candidemia fluconazole , Diflucan , itraconazole , voriconazole , amphotericin b , Sporanox , More... Esophageal Candidiasis fluconazole , Diflucan , itraconazole , voriconazole , amphotericin b , Sporanox , More... 1 more conditions...} } shade
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