Caspofungin

Caspofungin is an antifungal drug belonging to the echinocandin class. It is used to treat Aspergillus and Candida infections and works by inhibiting cell wall synthesis. Echinocandin antifungals inhibit the synthesis of glucan in the cell wall, probably via the enzyme 1,3-beta glucan synthase.

Caspofungin inhibits the synthesis of β-(1,3)-D-glucan, an essential component of the cell wall of Aspergillus species and Candida species. β-(1,3)-D-glucan is not present in mammalian cells. The primary target is β-(1,3)-glucan synthase.

Caspofungin is indicated for empirical therapy for presumed fungal infections in febrile, neutropenic patients, treatment of candidemia and other Candida infections (intra-abdominal abscesses, peritonitis, pleural space infections), treatment of esophageal candidiasis, and treatment of invasive aspergillosis in patients refractory to or intolerant of other therapies.

• Empirical therapy for presumed fungal infections in febrile, neutropenic patients
• Candidemia and other Candida infections (intra-abdominal abscesses, peritonitis, pleural space infections)
• Esophageal candidiasis
• Invasive aspergillosis in patients refractory to or intolerant of other therapies

Adults (All indications except esophageal candidiasis): Day 1: 70 mg loading dose (1 hour IV infusion), then 50 mg IV daily.

Esophageal Candidiasis (Adults): 50 mg IV daily (no loading dose).

Hepatic impairment (Adults): Mild (Child-Pugh 5-6): No adjustment; Moderate (Child-Pugh 7-9): 70 mg loading, then 35 mg/day; Severe (Child-Pugh >9): Safety and efficacy not established.

Concomitant administration (CYP3A4 inducers - rifampin, nevirapine, efavirenz, carbamazepine, dexamethasone, phenytoin): Adults: 70 mg/day.

Children (3 months-17 years): BSA-based dosing: Day 1: 70 mg/m² loading, then 50 mg/m²/day (max 70 mg/day). With concomitant inducers: up to 70 mg/m²/day (max 70 mg/day).

Renal impairment: No dose adjustment needed.

Administration: Slow IV infusion (approximately 1 hour) - not IV bolus. Do not use diluents containing dextrose.

Adults (≥10%): Diarrhea, pyrexia (fever), increased ALT/AST, increased blood alkaline phosphatase, decreased blood potassium.

Pediatric (≥10%): Pyrexia (fever), diarrhea, rash, increased ALT/AST, decreased blood potassium, hypotension, chills.

Other: Chills, decreased blood potassium, diarrhea, fever, increased alkaline phosphatase, increased liver enzymes, rash, injection site reactions (pain, swelling, redness).

Regular monitoring of liver function is recommended.

• Anaphylaxis has been reported; if occurs, discontinue caspofungin and administer appropriate treatment.
• Possible histamine-mediated reactions (rash, facial swelling, angioedema, pruritus, sensation of warmth, bronchospasm) may require discontinuation and/or appropriate treatment.
• Can cause abnormalities in liver enzymes; monitor liver function and evaluate risk/benefit.
• Concomitant use with cyclosporine may increase liver enzymes; limit use to patients for whom potential benefit outweighs potential risk.
• Use during pregnancy only if clearly needed (Category C).
• Caution during lactation.

• Known hypersensitivity to caspofungin or any component

• Rifampin (CYP3A4 inducer): Decreases caspofungin plasma concentrations; increase dose to 70 mg/day.
• Nevirapine, efavirenz, carbamazepine, dexamethasone, phenytoin: Consider dose increase to 70 mg/day.
• Cyclosporine: May increase liver enzymes; monitor liver function.
• Tacrolimus: May decrease blood concentration; monitor tacrolimus trough levels and adjust dose.