caspofungin acetate: clinical use

Prescribing considerations

• Initiation should be supervised by a clinician experienced in invasive fungal infection.
• Confirm that the suspected organism and infection site fall within caspofungin's expected spectrum; activity against less common yeasts and non-Aspergillus moulds is not established.
• Review hepatic function, previous serious allergic skin reactions and interacting medicines.
• Clinical data are limited in very young infants, severe adult hepatic impairment and paediatric hepatic impairment.
• During continuous renal replacement therapy, polyacrylonitrile-derived membranes may adsorb caspofungin and risk reduced efficacy; consider an alternative membrane or antifungal.

Contraindications and cautions

• Hypersensitivity to caspofungin or any excipient.

Monitoring

• Clinical and microbiological response.
• Liver function before and during treatment, particularly if results become abnormal or cyclosporin is used.
• Infusion-related hypersensitivity and severe skin reactions.
• Blood count, potassium and other laboratory abnormalities as clinically indicated.
• Tacrolimus trough concentrations when used concurrently.

Clinical pharmacology

A highly albumin-bound echinocandin that inhibits fungal beta-(1,3)-D-glucan synthesis. It undergoes spontaneous degradation with peptide hydrolysis and N-acetylation, has little unchanged urinary excretion and is not dialysable.

Formulation and product differences

• The selected product is a powder for concentrate requiring aseptic reconstitution and dilution before intravenous infusion.
• Use water for injection for reconstitution and an authorised sodium chloride or lactated Ringer's solution for final dilution.
• Do not use glucose-containing diluents or mix with other medicines because compatibility and stability are unsuitable.
• The selected formulation is essentially sodium-free.

Solution for infusion

Route: Intravenous

Strengths: 50 mg, 70 mg