Caspofungin

CLINICAL USE

Invasive aspergillosis in adult patients who are refractory to or intolerant of amphotericin B and/or itraconazole

Invasive candidiasis

Empirical treatment of systemic fungal infections in patients with neutropenia

DOSE IN NORMAL RENAL FUNCTION

70 mg loading dose on day 1 followed by 50 mg daily, thereafterIf patient weighs >80 kg use 70 mg daily

PHARMACOKINETICS

Molecular weight :1213.4 (as acetate)

%Protein binding :97

%Excreted unchanged in urine : 1.4

Volume of distribution (L/kg) :No data

half-life – normal/ESRD (hrs) :12–15 days/Increased but not significantly.

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unlikely to be dialysed. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Ciclosporin: monitor liver enzymes as transient increases in ALT and AST have been reported with concomitant administration. Avoid co-administration if possible. Increases AUC of caspofungin by 35%

Tacrolimus: reduces tacrolimus trough concentration by 26%

ADMINISTRATION

Reconstition

10.5 mL water for injection

Route

IV infusion

Rate of Administration

Approximately 1 hour

Comments

Caspofungin is unstable in fluids containing glucose; add to 250 mL sodium chloride 0.9% or lactated Ringer’s solution

If patient is fluid restricted, doses of 35 or 50 mg may be added to 100 mL infusion fluid

OTHER INFORMATION

In established renal failure the AUC is increased by 30–49% but a change in dosage schedule is not required

Plasma concentrations of caspofungin decline in a polyphasic manner. A short α-phase occurs immediately post infusion, followed by a β-phase with a half-life of 9–11 hours. An additional γ-phase also occurs with a half-life of 40–50 hours. Distribution rather than excretion or biotransformation is the dominant mechanism influencing plasma clearance

Caspofungin has been used at a dose of 50 mg daily in combination with IV amphotericin B to successfully treat fungal peritonitis

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