Usual Adult Dose for Febrile Neutropenia

Loading dose: 70 mg IV on Day 1
Maintenance dose: 50 mg IV once a day thereafter

• If the 50 mg dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg IV once a day

Comments:

• Treatment duration should be based on the patient's clinical response; empirical therapy should continue until resolution of neutropenia.
• In general, patients found to have a fungal infection should be treated for at least 14 days after the last positive culture and continue for at least 7 days after both neutropenia and clinical symptoms are resolved.

Use: As empirical therapy for presumed fungal infections in febrile, neutropenic patients

Usual Adult Dose for Candidemia

Loading dose: 70 mg IV on Day 1
Maintenance dose: 50 mg IV once a day thereafter

Comments:

• Treatment duration should be based on the patient's clinical and microbiological response; in general, antifungal therapy should continue for at least 14 days after the last positive culture.
• Patients who remain persistently neutropenic may require longer therapy pending resolution of the neutropenia.
• This drug has not been studied in endocarditis, osteomyelitis, and meningitis due to Candida.

Uses: For the treatment of candidemia and the following Candida infections: intraabdominal abscesses, peritonitis, and pleural space infections

Usual Adult Dose for Esophageal Candidiasis

50 mg IV once a day
Duration of therapy: 7 to 14 days after symptom resolution

Comments:

• A 70 mg loading dose has not been studied with this indication.
• This drug has not been approved for treatment of oropharyngeal candidiasis (higher relapse rate).
• Due to the risk of relapse of oropharyngeal candidiasis in patients with HIV infections, suppressive oral therapy could be considered.

Use: For the treatment of esophageal candidiasis

Usual Adult Dose for Aspergillosis - Invasive

Loading dose: 70 mg IV on Day 1
Maintenance dose: 50 mg IV once a day thereafter

Comments:

• Treatment duration should be based on the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.
• This drug has not been studied as initial therapy for invasive aspergillosis.

Use: For the treatment of invasive aspergillosis in patients refractory to/intolerant of other therapies

Usual Pediatric Dose for Febrile Neutropenia

3 months or older:

• Loading dose: 70 mg/m2 IV on Day 1
• Maintenance dose: 50 mg/m2 IV once a day thereafter
• If the 50 mg/m2 dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg/m2 IV once a day

Maximum dose (loading and maintenance): 70 mg/dose

Comments:

• The maximum loading dose and daily maintenance dose should not exceed 70 mg, regardless of patient's calculated dose.
• Treatment duration should be based on the patient's clinical response; empirical therapy should continue until resolution of neutropenia.
• In general, patients found to have a fungal infection should be treated for at least 14 days after the last positive culture and continue for at least 7 days after both neutropenia and clinical symptoms are resolved.

Use: As empirical therapy for presumed fungal infections in febrile, neutropenic patients

Usual Pediatric Dose for Candidemia

3 months or older:

• Loading dose: 70 mg/m2 IV on Day 1
• Maintenance dose: 50 mg/m2 IV once a day thereafter
• If the 50 mg/m2 dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg/m2 IV once a day

Maximum dose (loading and maintenance): 70 mg/dose

Comments:

• The maximum loading dose and daily maintenance dose should not exceed 70 mg, regardless of patient's calculated dose.
• Treatment duration should be based on the patient's clinical and microbiological response; in general, antifungal therapy should continue for at least 14 days after the last positive culture.
• Patients who remain persistently neutropenic may require longer therapy pending resolution of the neutropenia.
• This drug has not been studied in endocarditis, osteomyelitis, and meningitis due to Candida.

Uses: For the treatment of candidemia and the following Candida infections: intraabdominal abscesses, peritonitis, and pleural space infections

Usual Pediatric Dose for Esophageal Candidiasis

3 months or older:

• Loading dose: 70 mg/m2 IV on Day 1
• Maintenance dose: 50 mg/m2 IV once a day thereafter
• If the 50 mg/m2 dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg/m2 IV once a day

Maximum dose (loading and maintenance): 70 mg/dose
Duration of therapy: 7 to 14 days after symptom resolution

Comments:

• The maximum loading dose and daily maintenance dose should not exceed 70 mg, regardless of patient's calculated dose.
• This drug has not been approved for treatment of oropharyngeal candidiasis (higher relapse rate).
• Due to the risk of relapse of oropharyngeal candidiasis in patients with HIV infections, suppressive oral therapy could be considered.

Use: For the treatment of esophageal candidiasis

Usual Pediatric Dose for Aspergillosis - Invasive

3 months or older:

• Loading dose: 70 mg/m2 IV on Day 1
• Maintenance dose: 50 mg/m2 IV once a day thereafter
• If the 50 mg/m2 dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg/m2 IV once a day

Maximum dose (loading and maintenance): 70 mg/dose

Comments:

• The maximum loading dose and daily maintenance dose should not exceed 70 mg, regardless of patient's calculated dose.
• Treatment duration should be based on the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.
• This drug has not been studied as initial therapy for invasive aspergillosis.

Use: For the treatment of invasive aspergillosis in patients refractory to/intolerant of other therapies

Renal Dose Adjustments

Renal dysfunction: No adjustment recommended.

Liver Dose Adjustments

Adult patients:

• Mild liver dysfunction (Child-Pugh score 5 to 6): No adjustment recommended.
• Moderate liver dysfunction (Child-Pugh score 7 to 9):
• Loading dose (where appropriate): 70 mg IV on Day 1
• Maintenance dose: 35 mg IV once a day
• Severe liver dysfunction (Child-Pugh score greater than 9): Data not available

Pediatric patients:

• Any degree of liver dysfunction: Data not available

Dose Adjustments

Adult patients:

• On rifampin: Should receive caspofungin 70 mg IV once a day
• On other inducers of hepatic CYP450 enzymes (e.g., nevirapine, efavirenz, carbamazepine, dexamethasone, phenytoin): Should consider caspofungin 70 mg IV once a day

Pediatric patients:

• On rifampin: Should receive caspofungin 70 mg/m2 IV once a day
• Maximum dose: 70 mg/dose
• On other inducers of hepatic CYP450 enzymes (e.g., efavirenz, nevirapine, phenytoin, dexamethasone, carbamazepine): Should consider caspofungin 70 mg/m2 IV once a day
• Maximum dose: 70 mg/dose

Precautions

CONTRAINDICATIONS:
Known hypersensitivity (e.g., anaphylaxis) to the active component or any of the ingredients

Safety and efficacy have not been established in patients younger than 3 months.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is not dialyzable; supplementary dosing is not required after hemodialysis.

Other Comments

Administration advice:

• Administer by slow IV infusion over about 1 hour; do not administer by IV bolus injection.
• Do not mix or co-infuse with other agents.

Storage requirements:

• Lyophilized vials: Store refrigerated at 2C to 8C (36F to 46F).
• Reconstituted solution (in vial): May store for up to 1 hour at up to 25C (77F) before preparation of the infusion solution
• Diluted infusion solution (in IV bag/bottle): Must use within 24 hours if stored at up to 25C (77F) or within 48 hours if stored refrigerated at 2C to 8C (36F to 46F).

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

IV compatibility:

• Compatible (reconstitution): 0.9% Sodium Chloride Injection, Sterile Water for Injection, Bacteriostatic Water for Injection with methylparaben and propylparaben, Bacteriostatic Water for Injection with 0.9% benzyl alcohol
• Compatible (dilution): 0.9%, 0.45%, or 0.225% Sodium Chloride Injection; Lactated Ringers Injection
• Compatibility of this drug with other IV substances, additives, or medications has not been established.
• Do not use diluents containing dextrose (alpha-D-glucose); this drug is not stable in such diluents.

Monitoring:

• Hepatic: For evidence of worsening hepatic function in patients who develop abnormal liver function tests (during therapy)

Patient advice:

• Report signs/symptoms of hypersensitivity reaction (including rash, facial swelling, angioedema, pruritus, sensation of warmth, bronchospasm) to healthcare provider.