Antimicrobials
Caspofungin
Guidelines for use
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1. Spectrum of activity
Active against:
- Candida species: C. albicans, C. glabrata, C. parapsilosis (typically less active than fluconazole), C. tropicalis, C. krusei
- Aspergillus species
Not active against:
- Cryptococcus species
- Dimorphic Fungi (Histoplasma, Coccidiodes, Blastomyces)
- Zygomycetes
2. Clinical Use (consult Infectious Diseases)
- Empiric treatment of invasive candidiasis in critically-ill or neutropenic patients
- Treatment of mucocutaneous or systemic candidiasis (typically reserved for azole-resistant isolates)
- Treatment of aspergillus infections (typically second-line to voriconazole)
3. Inappropriate Uses
- Fungal infections involving the CNS
- Fungal endophthalmitis
4. Precautions
- Metabolism of caspofungin may be increased with co-administration of CYP 450 enzyme inducers (e.g. phenytoin, carbamazepine, rifampin): screen for drug interactions (see Dosing Guidelines)
- Dose reduction required in patients with moderate hepatic impairment (Child-Pugh Score 7-9); not recommended in patients with severe hepatic impairment (Child-Pugh Score > 9)
- Pregnancy and breastfeeding - for safety information, see Table on Safety of Anti-infective therapy in Pregnancy & Lactation
5. Adverse Effects
Generally well tolerated
- Mild transaminitis
- Mild GI upset (nausea, vomiting and diarrhea)
- Histamine-related infusion-mediated reactions (rash, facial swelling); consider pre-medication with an antihistamine
6. Dosage
- Usual Dosage: 70 mg IV loading dose, then 50 mg IV Q24H
- Concomitant CYP 450 inducers (e.g. phenytoin, carbamazepine, rifampin): 70 mg IV Q24H
- Moderate hepatic impairment (Child-Pugh Score 7-9): 70 mg IV loading dose, then 35 mg IV Q24H
Renal Insufficiency: no dose adjustment in renal impairment
7. Monitoring
- Baseline and periodic LFTs throughout therapy
