Caspofungin (Cancidas)

Caspofungin - covers a wider range of Candida species causing invasive candidiasis than fluconazole and is active against Aspergillus species. It has a better side-effect profile than amphotericin. Side-effects are typically mild and rarely lead to discontinuation.

Uses:
Invasive candidiasis
Invasive aspergillosis

Contraindications:
Breastfeeding

Administration:
• IV: Load with 70 mg on day 1, followed by 50 mg daily thereafter typically for a minimum of 14 days If >80 kg, continue with maintenance dose of 70 mg daily

Reconstitute with 10 ml WFI. Add the reconstituted solution to a 100 ml or 250 ml bag of sodium chloride 0.9% or Hartmann’s solution, given over 1 hour.

Available in vials containing 50 mg and 70 mg powder. Store vials in fridge at 2–8°C.

How not to use caspofungin:
Do not use diluents containing glucose

Adverse effects:
Thrombophlebitis
Fever
Headache
Tachycardia
Anaemia
Decreased platelet count
Elevated LFT
Hypokalaemia
Hypomagnesaemia

Cautions:
Co-administration with the inducers efavirenz, nevirapine, rifampicin, dexamethasone, phenytoin or carbamazepine may result in a decrease in caspofungin AUC, so increase in the daily dose of caspofungin to 70 mg. Ciclosporin increases the AUC of caspofungin by approximately 35%. Caspofungin lowers trough concentrations of tacrolimus by 26% Initially, rifampicin causes a 170% increase in trough concentration of caspofungin on the first day of co-administration; after 2 weeks trough levels of caspofungin are reduced by 30%

Organ failure:
Renal: No dose adjustment necessary
Hepatic: Mild (Child–Pugh score 5–6): no dose adjustment Moderate (Child-Pugh score 7–9): 70 mg loading followed by 35 mg daily
Severe (Child-Pugh score >9): no data

Organ replacement therapy:
Not removed by dialysis