Caspofungin
Mechanism :
Caspofungin acetate inhibits the synthesis of b (1,3)-D-glucan, an essential component of the cell wall of susceptible Aspergillus species and Candida species. b (1,3)-D-glucan is not present in mammalian cells. Caspofungin has shown activity against Candida species and in regions of active cell growth of the hyphae of Aspergillus fumigatus.
Indication :
- Treatment of candidemia and invasive candidiasis.
- Treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies.
Contraindications :
Caspofungin is contraindicated in patients with hypersensitivity to any component of this product.
Dosing :
>3 months:
Loading dose:
70 mg/m²/day on day 1, max 70 mg, followed by 50 mg/m²/day, Max: 50 mg OD.
Duration of treatment should be based on the patients clinical response.
Adverse Effect :
Histamine-mediated symptoms of rash, facial swelling, pruritus, sensation of warmth, or bronchospasm, anaphylaxis.
Interaction :
For patients receiving both therapies, standard monitoring of tacrolimus blood concentrations and appropriate tacrolimus dosage adjustments are recommended.
Cyclosporine (one 4 mg/kg dose or two 3 mg/kg doses): Increased the AUC of caspofungin by approximately 35% There were transient increases in liver ALT and AST when co-administered.
Rifampin: A drug-drug interaction study with rifampin in healthy volunteers has shown a 30% decrease in caspofungin trough concentrations.
Inducers of drug clearance: Co-administration of other inducers of drug clearance (efavirenz, nevirapine, phenytoin, dexamethasone, or carbamazepine) may result in clinically meaningful reductions in caspofungin concentrations. Use of a daily dose of 70 mg should be considered.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
20-50 | Dose as in normal renal function |
10-20 | 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 |
Hepatic Dose :
Mild hepatic impairment: No dose adjustment needed.
Moderate hepatic impairment: No change in loading dose needed. Give maintenance dose of 35 mg/sqm/day.
Severer hepatic impairment: No data available.