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