Generic Name

Caspofungin Acetate

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Classification

FDA Approved Indications

• Invasive candidiasis (including candidemia)
• Invasive aspergillosis (as salvage therapy or when other agents are unsuitable)

Mechanism of Action

Inhibits synthesis of β-1,3-D-glucan, an essential component of the fungal cell wall, leading to cell lysis and death.

Dosage and Administration

Adult: 70 mg IV loading dose on day 1, then 50 mg IV daily; doses may be increased to 70 mg if certain conditions are present.

Pediatric: Not approved for pediatric use under 3 months; for children 3 months and older, dosing depends on weight.

Geriatric: No adjustment necessary; monitor closely as with other patients.

Renal Impairment: No dose adjustment needed.

Hepatic Impairment: No adjustment needed, but use with caution and monitor liver function.

Pharmacokinetics

Absorption: Not absorbed orally; administered IV.

Distribution: Widely distributed in body tissues and fluids.

Metabolism: Minimal metabolism; primarily eliminated unchanged.

Excretion: Excreted mainly in feces via biliary excretion.

Half Life: 9-11 hours in adults.

Contraindications

• Hypersensitivity to caspofungin or other echinocandins.

Precautions

• Liver function impairment; monitor liver enzymes regularly.
• Use cautiously in patients with pre-existing hepatic disease.

Adverse Reactions - Common

• Histaminic reactions (rash, pruritus, erythema) (Less common)
• Elevated liver enzymes (Common)
• Headache, nausea, flushing (Common)

Adverse Reactions - Serious

• Anaphylaxis (Rare)
• Liver failure (Rare)

Drug-Drug Interactions

• Cyclosporine (may increase caspofungin levels)
• Rifampin (may decrease caspofungin levels)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report any signs of allergic reactions immediately.
• Inform about possible side effects like headache, flushing, or rash.
• Emphasize the importance of completing the full course of therapy.

Special Considerations

Black Box Warnings:

• None currently

Genetic Factors: No known genetic factors affecting response.

Lab Test Interference: May elevate liver enzymes, which should be interpreted carefully.

Overdose Management

Signs/Symptoms: Nausea, vomiting, hypotension, flushing.

Treatment: Supportive care, monitor vital signs, and provide symptomatic relief.

Storage and Handling

Storage: Store vials at 2-8°C (36-46°F), protected from light.

Stability: Stable until the expiration date when stored properly.