Names and pronunciation
(cas-po-fun′gin) Cancidas
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Drug reference
(cas-po-fun′gin) Cancidas
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Func. class.: Antifungal, systemic
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Chem. class.: Echinocandin
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ACTION: Inhibits an essential compo- nent in fungal cell walls; causes direct damage to fungal cell wall
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USES: Treatment of invasive aspergil- losis and candidemia that has not responded to other treatment, including peritonitis, intraabdominal abscesses; susceptible species: Aspergillus flavus, A. fumigatus, A. terreus, Candida albicans, C. glabrata, C. krusei, C. lusitaniae, C. parapsilosis, C. tropica- lis, esophageal candidiasis; empiric therapy for presumed fungal infection in febrile, neutropenic patients
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Unlabeled uses: Aspergillus niger, fun- gal infections in premature neonates, neonates, infants, children <2 yr
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children, geriatric patients, severe hepatic disease
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SIDE EFFECTS CNS: Dizziness, headache, fever, chills CV: Sinus tachycardia, hypertension GI: Abdominal pain, nausea, anorexia, vomiting, diarrhea, increased AST/ALT, alkaline phosphatase GU: Renal failure HEMA: Thrombophlebitis, vasculitis, anemia INTEG: Rash, pruritus, injection site pain META: Hypokalemia MS: Myalgia RESP: Acute respiratory distress syn- drome (ARDS), pleural effusions SYST: Anaphylaxis, histamine-related reactions, Stevens-Johnson syndrome
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INTERACTIONS Increase: caspofungin levels, hepatic toxic- ity—cycloSPORINE; avoid concurrent use Decrease: levels of tacrolimus, sirolimus Decrease: caspofungin levels—carBAMaze- pine, dexamethasone, efavirenz, nelfinavir, nevirapine, phenytoin, rifAMPin; caspofun- gin dose may need to be increased Drug/Lab Test Increase: AST, ALT, RBC, eosinophils, glu- cose, bilirubin, alkaline phosphatase, serum creatinine Decrease: Hct/HB, WBC, potassium, magnesium
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DOSAGE AND ROUTES Invasive aspergillosis • Adult: IV loading dose 70 mg on day 1, then 50 mg/day maintenance dose, depending on condition; max 70 mg/day; if receiving rifAMPin, carBAMazepine, dexa- methasone, phenytoin, use 70 mg daily • Adolescent/child/infant ≥3 mo: IV INFUSION 70 mg/m2 loading dose, then 50 mg/m2/day; max 70 mg/day • Neonate and infant <3 mo (unla- beled): IV 25 mg/m2/day Esophageal candidiasis • Adult: IV 70 mg loading dose then 50 mg × 14-21 days over 1 hr • Child 3 mo-17 yr: IV 70 mg/m2 loading dose over 1 hr, day 1, then 50 mg/m2/day Hepatic dose • Adult: IV (Child-Pugh 7-9, class B) loading dose 70 mg, then 35 mg/day • Child 3 mo-17 yr: IV 70 mg/m2 loading dose, then 50 mg/m2 daily; max 70 mg/m2
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Available forms: Powder for injection 50, 70 mg (single-use vials)
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Administer: • Do not mix or confuse with other med- ications; do not use dextrose-containing products to dilute; do not give as bolus Intermittent IV INFUSION route • Allow vial to warm to room temperature • May administer loading dose on day 1 • Reconstitute 50-mg vial or 70-mg vial with 10.8 mL 0.9% NaCl, sterile water for injection, or bacteriostatic water for injec- tion (5 mg/mL or [50-mg vial] 7 mg/mL [70-mg vial]), respectively; swirl to dis- solve, withdraw 10 mL reconstituted solu- tion, and further dilute with 250 mL 0.9% NaCl, 0.45% NaCl, 0.225% NaCl, LR; run over 1 hr or more • Store at room temperature for up to 24 hr or refrigerated for 48 hr; store re- constituted solution at room temperature for 1 hr before preparation of solution for administration • Monitor for injection site reactions
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Assess: • Infection: clearing of cultures during treatment; obtain culture at baseline, throughout treatment; product may be started as soon as culture is taken (esophageal candidiasis); monitor cul- tures during hematopoietic stem cell transplantation (HSCT) for prevention of Candida infections • Blood studies prior to, during treatment: bilirubin, AST, ALT, alkaline phosphatase, as needed; obtain baseline renal studies; CBC with differential, serum potassium • Hypersensitivity: rash, pruritus, facial swelling; also for phlebitis; anaphylaxis (rare) • GI symptoms: frequency of stools, cramping; if severe diarrhea occurs, electrolytes may need to be given • Pregnancy/breastfeeding: no well-con- trolled studies; use in pregnancy only if benefits outweigh fetal risk; excreted in breast milk, use cautiously in breastfeeding
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Evaluate: • Therapeutic response: decreased symp toms of Candida, Aspergillus infections
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To inform prescriber of renal/hepatic disease • To report bleeding, phlebitis, facial swelling, wheezing, difficulty breathing, itching, rash, hives, increasing warmth, flushing; anaphylaxis can occur • Pregnancy/breastfeeding: to notify prescriber if pregnancy is suspected or planned; to use cautiously in breastfeed- ing See cephalosporins—second generation See cephalosporins—first generation See cephalosporins—first generation See cephalosporins—third generation See cephalosporins—third generation See cephalosporins—third generation See cephalosporins—third generation See cephalosporins—third generation See cephalosporins—second generation See cephalosporins—second generation See cephalosporins—third generation See cephalosporins—second generation See cephalosporins—third generation See cephalosporins—third generation See cephalosporins—third generation See cephalosporins—third generation See cephalosporins—second generation
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PHARMACOKINETICS Metabolized in liver to inactive metabo- lites; excretion in feces, urine; half-life 9-11 hr; protein binding 97%
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• Adult: IV loading dose 70 mg on day 1, then 50 mg/day maintenance dose, depending on condition; max 70 mg/day; if receiving rifAMPin, carBAMazepine, dexa- methasone, phenytoin, use 70 mg daily
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• Adult: IV 70 mg loading dose then 50 mg × 14-21 days over 1 hr
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• Adult: IV (Child-Pugh 7-9, class B) loading dose 70 mg, then 35 mg/day
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