Caspofungin acetate for injection is a sterile, lyophilized product for intravenous (IV) infusion that contains a semi-synthetic lipopeptide (echinocandin) compound synthesized from a fermentation product of Glarea lozoyensis. Caspofungin acetate is an echinocandin anti-fungal that inhibits the synthesis of β (1, 3)-D-glucan, an integral component of the fungal cell wall.
Caspofungin acetate is 1-[(4R, 5S)-5-[(2-aminoethyl) amino]-N2-(10, 12-dimethyl-1oxotetradecyl)-4-hydroxy-L-ornithine]-5-[(3R)-3-hydroxy-L-ornithine] pneumocandin B0 diacetate (salt). Each vial of caspofungin acetate for injection, 50 mg, contains caspofungin acetate (equivalent to 54.6 mg of caspofungin free base; 4.6 mg excess is to ensure withdrawal of 50 mg caspofungin), arginine (100 mg), and hydrochloric acid/sodium hydroxide required for pH adjustment.
Each vial of caspofungin acetate for injection, 70 mg, contains caspofungin acetate (equivalent to 77.2 mg of caspofungin free base; 7.2 mg excess is to ensure withdrawal of 70 mg caspofungin), arginine (140 mg), and hydrochloric acid/sodium hydroxide required for pH adjustment.
Caspofungin acetate is a hygroscopic, white to off-white powder. It is freely soluble in water and methanol, and slightly soluble in ethanol. The pH of a saturated aqueous solution of caspofungin acetate is approximately 6.6.
Treatment of invasive Aspergillus infections in patients who are refractory or intolerant of other therapies; treatment of candidemia and other Candida infections (intra-abdominal abscesses, peritonitis, pleural space); treatment of esophageal candidiasis; empirical treatment for presumed fungal infections in febrile neutropenic patients
Aspergillosis (invasive): I.V.: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg once daily. Duration of therapy should be a minimum of 6-12 weeks or throughout period of immunosuppression and until lesions have resolved (Walsh, 2008). Salvage treatment with 70 mg once daily (unlabeled dosing) has been reported (Maertens, 2006).
Candidemia: I.V: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg once daily; generally continue for at least 14 days after the last positive culture or longer if neutropenia warrants. Higher doses (150 mg once daily infused over ~2 hours) compared to the standard adult dosing regimen (50 mg once daily) have not demonstrated additional benefit or toxicity in patients with invasive candidiasis (Betts, 2009).
Esophageal candidiasis: I.V.: 50 mg once daily; continue for 7-14 days after symptom resolution. Note: The majority of patients studied for this indication also had oropharyngeal involvement.
Empiric therapy: I.V.: Initial dose: 70 mg on day 1; subsequent dosing: 50 mg once daily; continue until resolution of neutropenia; if fungal infection confirmed, continue for a minimum of 14 days (continue for at least 7 days after resolution of both neutropenia and clinical symptoms); if clinical response inadequate, may increase up to 70 mg once daily if tolerated, but increased efficacy not demonstrated.
Concomitant use of Enzyme inducer:
Patients receiving rifampin: 70mg caspofungin daily. Patients receiving carbamazepine, dexamethasone, efavirenz, nevirapine or phenytoin (and possibly other enzyme inducer) may require an increased daily dose of caspofungin.
Common side effect: Hypotension, peripheral edema, tachycardia, Fever, chills, headache, Hypokalemia, Diarrhea, vomiting, nausea, Hypomagnesemia.