caspofungin acetate

caspofungin acetate

Cancidas

Pharmacologic class: Echinocandin

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 70 mg in single-use vials

Indications and dosages

Invasive aspergillosis in patients-refractory to or intolerant of other therapies

Adults ages 18 and older: 70 mg I.V. as a single loading dose on first day, followed by 50 mg/day thereafter

Children ages 3 months to 17 years: 70 mg/m2 I.V. as a single loading dose on first day, followed by 50 mg/m2/day thereafter. Maximum loading dosage and daily maintenance dosage shouldn't exceed 70 mg, regardless of calculated dosage.

Esophageal candidiasis

Adults ages 18 and older: 50 mg I.V. daily

Children ages 3 months to 17 years: 70 mg/m2 I.V. as a single loading dose on first day, followed by 50 mg/m2/day thereafter. Maximum loading dosage and daily maintenance dosage shouldn't exceed 70 mg, regardless of calculated dosage.

Candidemia and other Candida infections (intra-abdominal abscesses, peritonitis, and pleural-space infections)

Adults ages 18 and older: 70 mg I.V. as a single loading dose on first day, followed by 50 mg/day thereafter. Continue therapy for at least 14 days after last positive culture. Consistently neutropenic patient may require longer course of therapy.

Children ages 3 months to 17 years: 70 mg/m2 I.V. as a single loading dose on first day, followed by 50 mg/m2/day thereafter. Maximum loading dosage and daily maintenance dosage shouldn't exceed 70 mg, regardless of calculated dosage.

Empirical therapy for presumed fungal infections in febrile neutropenic patients

Adults ages 18 and older: 70 mg I.V. as a single loading dose on first day, followed by 50 mg/day thereafter. Continue therapy until neutropenia resolves, for at least 14 days in patients with fungal infections, or for at least 7 days after both neutropenia and symptoms resolve. If patient tolerates 50-mg dosage well but doesn't obtain adequate response, increase daily dosage to 70 mg.

Children ages 3 months to 17 years: 70 mg/m2 I.V. as a single loading dose on first day, followed by 50 mg/m2/day thereafter. Maximum loading dosage and daily maintenance dosage shouldn't exceed 70 mg, regardless of calculated dosage.

Dosage adjustment

• Moderate hepatic insufficiency (adults)

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• hepatic impairment

• renal insufficiency

• concurrent cyclosporine use

• pregnant or breastfeeding patients.

Administration

Don't mix with other drugs or with diluents containing dextrose.

• Reconstitute powder using 10.8 ml of normal saline solution for injection, sterile water for injection, or bacteriostatic water for injection. Mix gently until solution is clear. Add to I.V. bag or bottle containing 250 ml of normal, half-normal, or quarter-normal saline solution for injection or lactated Ringer's solution. Don't exceed concentration of 0.5 mg/ml.

Don't give by I.V. bolus.

• 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 oropharyngeal candidiasis relapse.

• Be aware that adults taking rifampin concurrently should receive 70-mg daily dosage.

• Know that dosage may need to be increased in patients receiving nevirapine, efavirenz, carbamazepine, dexamethasone, or phenytoin.

Adverse reactions

CNS: headache

CV: tachycardia, phlebitis, hypotension, hypertension (children)

GI: nausea, vomiting, diarrhea, abdominal pain

GU: nephrotoxicity

Hematologic: anemia

Metabolic: hypokalemia, hyperkalemia

Musculoskeletal: pain, myalgia, back pain

Respiratory: tachypnea, cough, dyspnea, crackles, pneumonia, respiratory distress (children), pleural effusion, respiratory failure

Skin: erythema, pruritus (children), rash

Other: graft-versus-host disease, central line infection (children), chills, mucosal inflammation, peripheral edema, pyrexia, infusion-related reactions, septic shock

Interactions

Drug-drug. Carbamazepine, dexamethasone, efavirenz, nelfinavir, nevirapine, phenytoin, rifampin: reduced caspofungin blood level

Cyclosporine: markedly increased caspofungin blood level, transient ALT and AST increases

Tacrolimus: possible change in tacrolimus blood level

Drug-diagnostic tests. Albumin, hematocrit, hemoglobin, magnesium, potassium, total protein (children), white blood cells: decreased levels ALP, ALT, AST, bilirubin, calcium, conjugated bilirubin, creatinine, eosinophils, glucose, urea: increased levels

Potassium: decreased or increased level (children)

Urinary red blood cells: positive

Patient monitoring

Monitor closely for signs and symptoms of infusion-related reactions (pyrexia, chills, flushing, hypotension, hypertension, tachycardia, dyspnea, tachypnea, anaphylaxis). Be prepared to provide supportive care as needed.

• Monitor I.V. site carefully for phlebitis and other complications.

• Monitor complete blood count and serum electrolyte levels. Stay alert for signs and symptoms of hypokalemia.

• Monitor vital signs, especially for tachycardia and tachypnea.

• Closely monitor liver function tests; watch for evidence of worsening hepatic function.

Patient teaching

Instruct patient to immediately report signs or symptoms of infusion-related reaction, such as fever, chills, flushing, rapid heart beat, difficult or rapid breathing, or rash.

Tell patient drug may cause problems in vein used for infusion. Tell him to immediately report pain, swelling, or other symptoms.

• Instruct patient to report headache, nausea, or other unusual or troublesome symptoms.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

References in periodicals archive ?
Caspofungin Acetate for Injection 50 mg per vial; 70 mg per vial (2 SKUs; vials)
Other drugs include itraconazole, caspofungin acetate and voriconazole.
On day 2, caspofungin acetate was added to his empirical anti-fungal infection regimen.
Cipla Limited introduced a number of new drugs and formulations, such as Adgain (vital nutritional supplement for hair loss); Capnea (caffeine citrate injection and oral solution) for apnoea of prematurity in infants; Caspogin (caspofungin acetate injection) for new antifungal for life-threatening fungal infections; Endobloc (ambrisentan tablets); Esomac (esomeprazole tablets); Evocort (formoterol and mometasone rotacaps)-new once-daily asthma controller therapy; Isablac (lactulose and isphaghula husk granules), and Ivabeat (ivabradine tablets) drug for coronary artery disease and chronic heart failure.
Caspofungin acetate (CAS) was provided by Merck & Co.
This report describes the case of a child with relapsed acute lymphoblastic leukemia (ALL) who developed cutaneous aspergillosis and subsequent multiorgan dissemination during therapeutic induction and was treated successfully with caspofungin acetate.
In view of the degenerating condition, amikacin was added to her treatment and liposomal amphotericin B was replaced with Echinocandin (caspofungin acetate) at a dose of 50mg following a loading dose of 70mg, for suspected refractory Aspergillus infection.
Caspofungin acetate is the first of a new class of antifungal agents, the echinocandins, that have fungicide activity against a wide range of pathogens including Aspergillus, Candida, and Histoplasmosis species (13,14).
Merck & Company, Whitehouse Station, NJ, received FDA approval to market Cancidas (caspofungin acetate) Intravenous Infusion for patients who are unresponsive to or cannot tolerate standard therapies for the invasive form of aspergillosis.