caspofungin (Rx)

Brand and Other Names:Cancidas
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 50mg/vial
  • 70mg/vial
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Candida Infections

Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections

Day 1 loading dose: 70 mg IV infused over 1 hr (as a single dose)

Maintenance: 50 mg IV qDay infused over 1 hr

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

Indicated for treatment of esophageal candidiasis

50 mg IV qDay infused over 1 hr, continue for 7-14 days after symptom resolution

Loading dose not necessary, has not been studied with this indication

May consider suppressive oral therapy in patients with HIV infection because of the risk of oropharyngeal candidiasis relapse

Invasive Aspergillosis

Indicated for invasive aspergillosis in patients refractory to or intolerant of other therapies (eg, amphotericin B, itraconazole)

Day 1 loading dose: 70 mg IV infused over 1 hr (as a single dose)

Maintenance: 50 mg IV qDay infused over 1 hr

Duration of treatment should be based upon the severity of the underlying disease, recovery from immunosuppression, and clinical response.

Febrile Neutropenia

Empirical therapy for presumed fungal infections in febrile, neutropenic patients

Day 1 loading dose: 70 mg IV infused over 1 hr

Maintenance: 50 mg IV qDay infused over 1 hour; if well tolerated but not achieving adequate response, may increase to 70 mg IV qDay

Duration of treatment should be based on clinical response; continue empirical therapy until resolution of neutropenia

If fungal infection is confirmed, continue therapy for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved

Candida auris (Off-label)

Based on the limited data, an echinocandin drug (eg, anidulafungin, caspofungin, micafungin) is recommended by the CDC as initial therapy for treatment of C auris infections

Day 1 loading dose: 70 mg/m² IV

Day 2 and thereafter: 50 mg/m² IV qDay

Dosage Modifications

Coadministration with strong CYP inducers (rifampin): 70 mg IV qDay

Coadministration with other drug clearance inducers: Consider increasing to 70 mg IV qDay

Hepatic impairment

  • Mild (Child-Pugh 5-6): No dosage adjustment necessary
  • Moderate (Child-Pugh 7-9): Load 70 mg IV, then 35 mg IV qDay
  • Severe (Child-Pugh >9): Safety and efficacy not established

Dosage Forms & Strengths

powder for injection

  • 50mg/vial
  • 70mg/vial
more...

Candida Infections

Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections

Dosing based on patient’s body surface area

<3 months: Safety and efficacy not established; limited data suggest off-label dose of 25 mg/m²/dose IV once daily

≥3 months

  • Day 1 loading dose: 70 mg/m² IV infused over 1 hr
  • Maintenance: 50 mg/m² IV qDay infused over 1 hr
  • If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay
  • Not to exceed 70 mg qDay
  • 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

Dosing based on patient’s body surface area

<3 months: Safety and efficacy not established

≥3 months

  • Day 1 loading dose: 70 mg/m² IV infused over 1 hr
  • Maintenance: 50 mg/m² IV qDay infused over 1 hr
  • If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay
  • Not to exceed 70 mg qDay
  • Continue antifungal therapy for 7-14 days after symptoms resolution

Invasive Aspergillosis

Dosing based on patient’s body surface area

<3 months: Safety and efficacy not established

≥3 months

  • Day 1 loading dose: 70 mg/m² IV infused over 1 hr
  • Maintenance: 50 mg/m² IV qDay infused over 1 hr
  • If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay
  • Not to exceed 70 mg qDay
  • Duration of treatment should be based upon the severity of the underlying disease, recovery from immunosuppression, and clinical response

Febrile Neutropenia

Empirical therapy for presumed fungal infections in febrile, neutropenic patients

Dosing based on patient’s body surface area

<3 months: safety and efficacy not established

≥3 months

  • Day 1 loading dose: 70 mg/m² IV infused over 1 hr
  • Maintenance: 50 mg/m² IV qDay infused over 1 hr
  • If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay
  • Not to exceed 70 mg qDay

Duration of treatment should be based on clinical response; continue empirical therapy until resolution of neutropenia

If fungal infection is confirmed, continue therapy for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved

Candida auris (Off-label)

Neonates and infants <2 months

  • In exceptional circumstances, where CNS involvement has been definitively ruled out, may consider use of caspofungin or micafungin with caution; the CDC recommends amphotericin B deoxycholate as initial treatment of choice
  • 25 mg/m²/day IV

≥2 months

  • Based on the limited data, an echinocandin drug (eg, anidulafungin, caspofungin, micafungin) is recommended by the CDC as initial therapy for treatment of C auris infections in adults and children aged ≥2 months
  • Day 1 loading dose: 70 mg/m² IV
  • Day 2 and thereafter: 50 mg/m² IV qDay

Dosage Modifications

Coadministration with CYP inducers (eg rifampin): Consider 70 mg/m² IV qDay, not to exceed 70 mg qDay

Hepatic impairment: Safety and efficacy not established

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Interactions

Interaction Checker

and caspofungin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Varies with condition

            Anaphylaxis reported during administration of Cancidas

            >10%

            Infused vein complications/ phlebitis (20-35%)

            Fever (6-30%)

            Diarrhea (6-27%)

            Shivering (9-23%)

            Rash (4-23%)

            Incr serum alk phos (9-22%)

            Hypotension (3-20%)

            Respiratory failure (2-20%)

            Incr transaminases (2-18%)

            Septic shock (11% to 14% )

            1-10% (selected)

            Pleural effusion (9%)

            Respiratory distress (up to 8%)

            Abdominal pain

            Nausea

            Vomiting

            Anemia

            Decreased Hgb

            Neutropenia

            Chills

            Hypokalemia

            Dizziness

            Erythema

            Facial edema, flushing

            Hematuria

            Hyperbilirubinemia

            Increased serum creatinine

            Induration

            Myalgia

            Pain

            Paresthesia

            Pruritus

            Sepsis

            Tachycardia

            <1%

            Erythema multiforme

            Stevens-Johnson syndrome

            Pancreatitis

            Hepatic necrosis

            Liver failure

            Anaphylaxis

            Nephrotoxicity

            Renal impairment

            Postmarketing Reports

            Blood and lymphatic system disorders: Anemia, coagulopathy, febrile neutropenia, neutropenia, thrombocytopenia

            Cardiac disorders: Arrhythmia, atrial fibrillation, bradycardia, cardiac arrest, myocardial infarction, tachycardia

            Gastrointestinal disorders: Abdominal distension, abdominal pain upper, constipation, dyspepsia

            General disorders and administration site conditions: Asthenia, fatigue, infusion site pain/pruritus/swelling, mucosal inflammation, edema

            Hepatobiliary disorders: Hepatic failure, hepatomegaly, hepatotoxicity, hyperbilirubinemia, jaundice

            Infections and infestations: Bacteremia, sepsis, urinary tract infection Metabolic and nutrition disorders: Anorexia, decreased appetite, fluid overload, hypomagnesemia, hypercalcemia, hyperglycemia, hypokalemia

            Musculoskeletal, connective tissue, and bone disorders: Arthralgia, back pain, pain in extremity

            Nervous system disorders: Convulsion, dizziness, somnolence, tremor

            Psychiatric disorders: Anxiety, confusional state, depression, insomnia

            Renal and urinary disorders: Hematuria, renal failure

            Respiratory, thoracic, and mediastinal disorders: Dyspnea, epistaxis, hypoxia, tachypnea

            Skin and subcutaneous tissue disorders: Erythema, petechiae, skin lesion, urticaria; toxic epidermal necrolysis

            Vascular disorders: Flushing, hypertension, phlebitis

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            Warnings

            Contraindications

            Hypersensitivity

            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

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known if excreted in breast milk, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Echinocandin; inhibits fungal cell wall synthesis

            Distribution

            Protein Bound: 97% to albumin

            Metabolism

            Slowly, via hydrolysis and N-acetylation as well as by spontaneous degradation with subsequent metabolism to component amino acids

            Elimination

            Half-life: 9-11 hr (beta phase); 40-50 hr (gamma phase)

            Excretion: 41% urine; 35% feces

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            Administration

            IV Incompatibilities

            Do not mix with dextrose-containing solutions or coadminister with other medications

            IV Preparation

            Reconstitute vial (70 mg for loading dose or 50 mg for daily dose) with 10.5 mL NS, SWI or BWI-may be stored for up to 1 hr at 25°C (or less)

            Mix gently to obtain clear soln-discard if particulate or discolored

            Transfer 10 mL of reconstituted solution to 250 mL NS, 1/2NS 1/4NS or LR

            Use infusion soln within 24 hr if stored at room temp or within 48 hr if refrigerated at 2-8°C

            If 70 mg vials are not available for preparation of the loading dose, reconstitute two 50 mg vials & transfer 14 mL to 250 mL NS, 1/2NS, 1/4NS or LR

            For 35 mg, reconstitute a 50 mg vial w/ 10 mL & transfer 7 mL to 250 mL (or 100 mL if medically necessary) infusion soln

            IV Administration

            Infuse IV slowly over 1 hr

            Storage

            Store vials at 2-8°C (36-46°F)

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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