Caspofungin

Caspofungin is a prescription medication used to treat Candida Infections, Esophageal Candidiasis, Invasive Aspergillosis, and Febrile Neutropenia. 

• Caspofungin is available under the following different brand names: Cancidas

Adult and pediatric dosage

Powder for Injection

• 50mg/vial
• 70mg/vial

Candida Infections

Adult dosage

• Day 1 loading dose: 70 mg IV infused over 1 hour (as a single dose)
• Maintenance: 50 mg IV once daily infused over 1 hour

Pediatric dosage

• Children younger than 3 months of age: Safety and efficacy not established; limited data suggest off-label dose of 25 mg/m2/dose IV once daily
• Children 3 months of age or older: 
• Day 1 loading dose: 70 mg/m2 IV infused over 1 hour
• Maintenance: 50 mg/m2 IV once daily over 1 hour
• If well tolerated but not achieving adequate response, may increase to 70 mg/m2 IV once daily
• Not to exceed 70 mg per day
• Continue antifungal therapy for at least 14 days after last positive culture; patients who remain persistently neutropenic may warrant longer course of therapy pending resolution of neutropenia

Esophageal Candidiasis

Adult dosage

• 50 mg IV once daily infused over 1 hour, continue for 7-14 days after symptom resolution

Pediatric dosage

• Children younger than 3 months of age: Safety and efficacy not established
• Children 3 months of age or older: 
  • Day 1 loading dose: 70 mg/m2 IV infused over 1 hour
  • Maintenance: 50 mg/m2 IV once daily infused over 1 hour
  • If well tolerated but not achieving adequate response, may increase to 70 mg/m2 IV once daily
  • Not to exceed 70 mg once daily
  • Continue antifungal therapy for 7-14 days after symptoms resolution

Invasive Aspergillosis

Adult dosage

• Day 1 loading dose: 70 mg IV infused over 1 hour (as a single dose)
• Maintenance: 50 mg IV once daily infused over 1 hour

Pediatric dosage

• Children younger than 3 months of age: Safety and efficacy not established
• Children 3 months of age or older: 
• Day 1 loading dose: 70 mg/m2 IV infused over 1 hour
• Maintenance: 50 mg/m2 IV once daily infused over 1 hour
• If well tolerated but not achieving adequate response, may increase to 70 mg/m2 IV once daily
• Not to exceed 70 mg once daily
• Duration of treatment should be based upon the severity of the underlying disease, recovery from immunosuppression, and clinical response

Febrile Neutropenia

Adult dosage

• Day 1 loading dose: 70 mg IV infused over 1 hour
• Maintenance: 50 mg IV once daily infused over 1 hour; if well tolerated but not achieving adequate response, may increase to 70 mg IV once per day

Pediatric dosage

• Empirical therapy for presumed fungal infections in febrile, neutropenic patients
• Dosing based on patient’s body surface area
• Children younger than 3 months of age: Safety and efficacy not established
• Children 3 months of age or older: 
  • Day 1 loading dose: 70 mg/m2 IV infused over 1 hour
  • Maintenance: 50 mg/m2 IV once daily infused over 1 hour
  • If well tolerated but not achieving adequate response, may increase to 70 mg/m2 IV once daily
  • Not to exceed 70 mg once daily

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Caspofungin include:

• diarrhea, 
• fever, 
• chills, 
• abnormal liver function tests, 
• skin rash, 
• dizziness, and
• lightheadedness

Serious side effects of Caspofungin include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• fever, 
• sore throat, 
• burning in your eyes, 
• skin pain, 
• red or purple skin rash that spreads and causes blistering and peeling, 
• pain, swelling, or vein irritation around the IV needle, 
• chills, 
• body aches, 
• flu symptoms, 
• swelling in hands or feet, 
• weakness, 
• muscle cramps, 
• pounding or uneven heartbeats, 
• confusion, 
• extreme thirst, 
• increased urination, 
• leg discomfort, 
• muscle weakness or limp feeling, 
• nausea, 
• upper stomach pain, 
• itching, 
• tired feeling, 
• loss of appetite, 
• dark urine, 
• clay-colored stools, and
• yellowing of the skin or eyes (jaundice)

Rare side effects of Caspofungin include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first

• Caspofungin has severe interactions with no other drugs.
• Caspofungin has serious interactions with the following drugs:
  • cyclosporine
  • eluxadoline
  • Saccharomyces boulardii
• Caspofungin has moderate interactions with at least 19 other drugs.
• Caspofungin has minor interactions with the following drugs:
  • dexamethasone
  • efavirenz
  • ethotoin
  • fosphenytoin
  • nelfinavir
  • nevirapine
  • phenytoin
  • tacrolimus
  • voclosporin

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity 

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Caspofungin?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Caspofungin?”

Cautions

• Anaphylaxis reported, discontinue and administer appropriate treatment; possible histamine-mediated adverse reactions, including rash, facial swelling, angioedema, pruritus, sensation of warmth or bronchospasm
• Do not use dextrose diluents
• Do not use with cyclosporine (unless benefits outweigh risks)
• Not for bolus administration
• Can cause abnormalities in hepatic enzyme levels
• Cyclosporine may increase AUC of Caspofungin by approximately 35%
• Hepatic effects: Abnormalities in LFTs and isolated cases of clinically significant hepatic dysfunction, hepatitis, or hepatic failure
• Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), some with a fatal outcome, reported; discontinue therapy at first sign or symptom of hypersensitivity reaction and administer appropriate treatment

Pregnancy and Lactation

• There are insufficient human data to establish whether there is a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes in pregnant women. 
• There are no data on the presence of drug in human milk, effects on breastfed child, or on milk production.