caspofungin

Actions and spectrum: 

caspofungin is an antifungal medication that belongs to the class of echinocandins. It is used to treat invasive fungal infections caused by Aspergillus and Candida species. caspofungin works by inhibiting the synthesis of beta (1,3)-D-glucan, a major component of fungal cell walls, resulting in weakening and eventual death of the fungal cell.

caspofungin is only effective against certain types of fungi and is not recommended for the treatment of non-fungal infections. It is typically used in patients who are unable to tolerate or have failed other antifungal therapies. 

DRUG INTERACTION

Contraindicated  

Serious Use Alternative  

Monitor Closely  

Minor  

Frequency defined 

>10% 

Increased transaminases (2-18%) 

Respiratory failure (2-20%) 

Hypotension (3-20%) 

Rash (4-23%) 

Diarrhoea (6-27%) 

Fever (6-30%) 

Shivering (9-23%) 

enhanced serum alkaline phosphatase levels (9-22%) 

Septic shock (11% to 14%) 

Infused vein complications/ phlebitis (20-35%)  

1-10% 

Pleural effusion (9%) 

Abdominal pain 

Respiratory distress (up to 8%) 

Nausea 

Anemia 

Neutropenia 

Hypokalemia 

Erythema 

Hematuria 

Increased serum creatinine 

Myalgia 

Paresthesia 

Sepsis 

Vomiting 

Decreased Hgb 

Chills 

Dizziness 

Facial edema, flushing 

Hyperbilirubinemia 

Induration 

Pain 

Pruritus 

Tachycardia  

<1% 

Erythema multiforme 

Pancreatitis 

Liver failure 

Nephrotoxicity 

Stevens-Johnson syndrome 

Hepatic necrosis 

Anaphylaxis 

Renal impairment  

Post marketing Reports 

lymphatic system and blood disorders: coagulopathy, neutropenia, Anemia, febrile neutropenia, thrombocytopenia. 

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

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

General disorders: Asthenia, infusion site swelling/pain/pruritus, peripheral edema, fatigue. 

Infections and infestations: sepsis, Bacteremia, urinary tract infection. 

Nutrition and metabolic disorders: decreased appetite, hypomagnesemia, hyperglycemia, Anorexia, fluid overload, hypercalcemia, hypokalemia.  

Nervous system disorders: dizziness, tremor, Convulsion, somnolence. 

Urinary and Renal disorders: renal failure, Hematuria. 

subcutaneous tissue and Skin disorders: petechiae, skin exfoliation, Erythema, skin lesion, urticaria. 

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

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

Psychiatric disorders: confusional state, insomnia, Anxiety, depression. 

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

Vascular disorders: hypertension, Flushing, phlebitis 

Black Box Warning:  

caspofungin does not have any black box warning. 

Contraindication/Caution: 

Contraindication: 

caspofungin is contraindicated in patients with a history of hypersensitivity to caspofungin acetate or any component of the formulation. It should also not be co-administered with drugs that are known to have a potential for hepatotoxicity, such as amphotericin B, aminoglycosides, or other hepatotoxic drugs. Additionally, caspofungin should not be used for the treatment of infections caused by Cryptococcus or Zygomycetes fungi.  

Caution: 

• Hepatic impairment: caspofungin is primarily metabolized in the liver and is eliminated through feces. Patients with severe hepatic impairment may have reduced clearance of caspofungin, leading to increased plasma levels and the risk of adverse effects.  
• Renal impairment: caspofungin is not significantly eliminated by the kidneys, so no dosage adjustment is necessary in patients with renal impairment. 
• Hypersensitivity: caspofungin should not be used in patients with known hypersensitivity to echinocandins, which are the class of antifungal drugs to which caspofungin belongs. 
• Use in pregnancy and lactation: The safety of caspofungin in pregnant women and nursing mothers has not been established.  
• Use in children: The safety and effectiveness of caspofungin in children under the age of 18 years have not been established. Therefore, the drug should be used in pediatric patients only when the potential benefits outweigh the potential risks.

comorbidities 

caspofungin is well-tolerated and can be used in patients with comorbidities such as liver and kidney impairment, although dose adjustments may be required. However, caution should be exercised when using caspofungin in patients with hypersensitivity to echinocandins, as well as in patients with a history of severe allergic reactions to other medications. caspofungin should also be used with caution in patients with a history of hepatotoxicity or liver disease. 

Pregnancy consideration: pregnancy category C 

Lactation: safety and efficacy not established  

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: There is no evidence of risk to the fetus found in animal reproduction studies and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for an effect in humans, care must be taken for potential risks in pregnant women. 
• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite potential risks may be used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits These category drugs should be prohibited for pregnant women. 
• Category N: There is no data available for the drug under this category. 

 

Pharmacology: 

caspofungin is an antifungal drug that belongs to the echinocandin class of drugs. It works by inhibiting the synthesis of β-(1,3)-D-glucan, one of the major components of the fungal cell wall. This inhibition leads to osmotic instability, causing cell death in susceptible fungi. caspofungin has activity against a broad spectrum of fungal pathogens, including Candida species, Aspergillus species, and some rare molds.  

Pharmacodynamics: 

caspofungin is an antifungal drug that belongs to the echinocandin class. It works by inhibiting the synthesis of beta-(1,3)-D-glucan, one of the major components of the fungal cell wall. This leads to the weakening of the cell wall and subsequent fungal cell death. caspofungin has activity against a broad range of fungi, including Candida species, Aspergillus species, and some other rare fungal species. 

caspofungin is a fungicidal agent, meaning that it kills the fungal cells rather than just inhibiting their growth. caspofungin has a broad spectrum of activity against many clinically important fungi, including those that are resistant to other antifungal drugs such as fluconazole or itraconazole.  

Pharmacokinetics: 

Absorption 

caspofungin is administered by intravenous infusion and therefore does not undergo absorption through the gastrointestinal tract. 

Distribution 

After administration, caspofungin is widely distributed throughout the body, with a volume of distribution of approximately 0.2 L/kg 

Metabolism 

caspofungin is not extensively metabolized, and the liver is the primary site of elimination. caspofungin is metabolized by hydrolysis and N-acetylation to inactive metabolites. 

Elimination and excretion 

The elimination half-life of caspofungin is 9-11 hours, and steady-state concentrations are reached after the third dose. caspofungin does not undergo significant hepatic metabolism or renal excretion and is eliminated through biliary excretion. 

Administration: 

caspofungin is administered intravenously (IV) by a healthcare provider in a hospital setting. It is usually given once a day, and the dosage depends on various factors such as the patient’s age, weight, and medical condition.

The infusion should be given over approximately one hour, and the injection site should be monitored for possible infusion-related reactions. It is important to follow the healthcare provider’s instructions for the proper administration of caspofungin. 

Patient information leaflet 

Generic Name: caspofungin 

Pronounced: [ KAS-poe-FUN-jin ]  

Why do we use caspofungin? 

caspofungin is one of the antifungal medications that is used to treat Candida auris infections. caspofungin belongs to a class of antifungal medications called echinocandins, which work by inhibiting the synthesis of the fungal cell wall. This prevents the growth and spread of the Candida auris fungus, ultimately leading to its death.

One of the benefits of caspofungin is that it has a broad spectrum of activity against many different types of fungi, including Candida auris. Additionally, studies have shown that caspofungin may be more effective than other antifungal medications, such as fluconazole, in treating Candida auris infections.