Pharmacologic class: Semisynthetic lipopeptide (echinocandin)
Therapeutic class: Antifungal
Pregnancy risk category C
Inhibits synthesis of 1,3-β-D-glucan, an essential component of fungal cell walls
Powder for reconstitution for infusion (lyophilized): 50-mg and 100-mg single-use vials
Indications and dosages
➣ Candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses
Adults: 100 mg daily by I.V. infusion over 1 hour for 15 days (range, 10 to 47 days)
➣ Esophageal candidiasis
Adults: 150 mg daily by I.V. infusion over 1 hour for 15 days (range, 10 to 30 days)
➣ Prophylaxis of Candida infections in patients undergoing hematopoietic stem-cell transplantation
Adults: 50 mg daily by I.V. infusion over 1 hour for 19 days (range, 6 to 51 days)
• Hypersensitivity to drug, its components, or other echinocandins
Use cautiously in:
• renal or hepatic disease
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• Administer by I.V. infusion only.
• Reconstitute with 5 ml normal saline solution injection (without bacteriostatic agent) or dextrose 5% injection added to 50-mg or 100-mg vial to yield approximately 10 mg/ml or 20 mg/ml, respectively.
• To minimize excessive foaming, gently dissolve powder by swirling vial. Don't shake vigorously.
• Protect diluted solution from light.
• Add reconstituted solution to 100 ml normal saline solution or 100 ml dextrose 5% before infusing.
• Flush existing I.V. line with normal saline solution before infusing drug.
• Infuse over 1 hour. Be aware that more rapid infusion increases risk of histamine-mediated reactions (rash, pruritus, facial swelling, vasodilation).
☞ If serious hypersensitivity (anaphylaxis or anaphylactoid) reaction occurs, immediately discontinue infusion and provide appropriate interventions.
CNS: headache, insomnia, fatigue, rigors, dizziness, anxiety
CV: vasodilation, hypotension, hypertension, bradycardia, tachycardia, phlebitis, flushing, atrial fibrillation
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, anorexia, decreased appetite
Hematologic: anemia, thrombocytopenia, aggravated anemia, neutropenia, febrile neutropenia
Metabolic: fluid retention, fluid overload
Musculoskeletal: back pain
Respiratory: pneumonia, cough, dyspnea
Skin: rash, pruritus, decubitus ulcers, erythema
Other: facial swelling, injection-site reaction, infection, bacteremia, fever, mucosal inflammation, peripheral edema, sepsis, septic shock, hypersensitivity reaction (including anaphylaxis, anaphylactoid reactions, and shock)
Drug-drug. Itraconazole, nifedipine, sirolimus: increased risk of toxicity
Drug-diagnostic tests. ALP, ALT, AST, sodium: increased levels
Calcium, glucose, magnesium, potassium: decreased levels
Liver function tests: abnormal
• If patient develops clinical or laboratory evidence of hematologic abnormalities, abnormal liver function tests, or electrolyte disorders, monitor closely for signs or symptoms that these conditions are getting worse. Risks against benefits of continuing therapy should be considered.
• Instruct patient to contact prescriber if unusual symptoms develop or if preexisting symptoms persist or get worse.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.