caspofungin acetate

caspofungin acetate

Cancidas

Pharmacologic class: Glucan synthesis inhibitor

Therapeutic class: Antifungal

Pregnancy risk category C

Action

Inhibits synthesis of beta (1, 3)-D-glucan, an important component of cell wall in Aspergillus and other fungal cells. This inhibition leads to cell rupture and death.

Availability

Lyophilized powder for injection: 50 mg and 75 mg in single-use vials

⊘Indications and dosages

➣ Invasive aspergillosis

Adults: 70 mg I.V. as a single loading dose on first day, followed by 50 mg/day thereafter

➣ Esophageal candidiasis

Adults: 50 mg daily by slow I.V. infusion

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:
• hepatic impairment
• bone marrow depression
• renal insufficiency
• pregnant or breastfeeding patients.

Administration

☞ Don't mix with other drugs or with diluents containing dextrose.
• Reconstitute powder using 0.9% sodium chloride for injection or bacteriostatic water for injection. Mix gently until solution is clear; further dilute with sodium chloride or lactated Ringer's solution.
• Administer by slow I.V. infusion over 1 hour.
• Know that in patients with human immunodeficiency virus, oral therapy may be given to help prevent relapse of oropharyngeal candidiasis.

Route	Onset	Peak	Duration
I.V.	Immediate	9-11 hr	40-50 hr

Adverse reactions

CNS: headache, paresthesia

CV: tachycardia, phlebitis

GI: nausea, vomiting, diarrhea, abdominal pain, anorexia

Hematologic: eosinophilia, anemia

Metabolic: hypokalemia

Musculoskeletal: pain, myalgia

Respiratory: tachypnea

Skin: histamine-mediated symptoms (including rash, facial swelling, pruritus, and warm sensation)

Interactions

Drug-drug. Cyclosporine: markedly increased caspofungin blood level

Inducers of drug clearance, mixed inducers-inhibitors (carbamazepine, dexamethasone, efavirenz, nelfinavir, nevirapine, phenytoin, rifampin): reduced caspofungin blood level

Tacrolimus: possible alteration in tacrolimus blood level

Drug-diagnostic tests. Alkaline phosphatase, eosinophils: increased levels

Hemoglobin, potassium: decreased levels

Patient monitoring

• Monitor I.V. site carefully for phlebitis and other complications.
• Monitor CBC and serum electrolyte levels. Watch for signs and symptoms of hypokalemia.
• Stay alert for histamine-mediated signs and symptoms (rash, facial swelling, pruritus, and sensation of warmth).
• Monitor vital signs, especially for tachycardia and tachypnea.
• Monitor nutritional and hydration status.

Patient teaching

• Teach patient about histamine-mediated signs and symptoms. Tell him when to notify prescriber.
• Advise patient to minimize GI adverse effects by eating small, frequent servings of healthy food and ensuring adequate fluid intake.
☞ Tell patient that drug may irritate vein used for infusion. Encourage him to immediately report pain, swelling, or other symptoms.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.