CASPOFUNGIN 50MG INJ 1`S

Caspofungin is a powerful antifungal medicine belonging to a class called echinocandins. It was the first echinocandin approved for clinical use (2001) and works by attacking the fungal cell wall — a structure that does not exist in human cells — making it highly selective against fungi with minimal human toxicity.

It is used to treat serious, invasive fungal infections in patients who are critically ill, immunocompromised, or for whom other antifungals have failed or cannot be tolerated. It is administered only by slow IV infusion in a hospital setting.

Approved Uses

•     Empirical antifungal treatment in febrile, neutropenic patients (when a fungal infection is suspected but not confirmed)

•     Candidaemia (Candida fungus in the bloodstream)

•     Invasive Candida infections: intra-abdominal abscesses, peritonitis, pleural space infections

•     Oesophageal candidiasis (Candida infection of the gullet)

•     Invasive aspergillosis — in patients who are refractory to or intolerant of other antifungals (e.g. amphotericin B, itraconazole)

Adults — Most Indications

•     Loading dose: 70 mg IV on Day 1

•     Maintenance: 50 mg IV once daily from Day 2 onward

•     Duration: Based on clinical response and resolution of infection — typically 14 days beyond resolution of candidaemia or last positive culture (6-12 weeks)

Adults — Oesophageal Candidiasis

•     70 mg on day 1, then 50 mg IV once daily (no loading dose required)

•     Duration: 7–14 days

Patients on CYP3A4 Inducers (rifampicin, nevirapine, carbamazepine, phenytoin, dexamethasone)

•     Consider increasing the maintenance dose to 70 mg/day

Children (3 months to 17 years)

•     Loading dose: 70 mg/m² (maximum 70 mg) on Day 1

•     Maintenance: 50 mg/m² (maximum 50 mg) once daily

Hepatic Impairment — Moderate (Child-Pugh B)

•     Reduce maintenance dose to 35 mg/day

Common (may affect more than 1 in 10 patients)

•     Fever

•     Nausea and vomiting

•     Phlebitis or thrombophlebitis at the infusion site

•     Tachycardia (increased heart rate)

•     Rash and skin flushing

•     Headache and diarrhoea

•     Elevated liver enzymes (ALT, AST) — monitor liver function

Serious — Tell Your Doctor or Nurse Immediately

•     Severe allergic reactions / anaphylaxis: Stop infusion immediately; treat with adrenaline, antihistamines, corticosteroids

•     Severe skin reactions: Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) — rare but potentially fatal; stop immediately if a severe rash develops

•     Significant hepatotoxicity: Discontinue if serious liver injury occurs

•     Known hypersensitivity to caspofungin or any ingredient in the formulation

•     Co-administration with cyclosporine: Not recommended unless clearly essential — risk of additive hepatotoxicity and elevated caspofungin levels

Pregnancy

Limited data. Caspofungin caused fetal abnormalities in animal studies. Use only if the potential benefit clearly outweighs the risk — serious fungal infections in pregnancy carry significant maternal risk.

Breastfeeding

Unknown if caspofungin passes into breast milk. Exercise caution — weigh benefits against risks.

Children under 3 Months

Safety and efficacy not established in neonates. Not recommended.

Liver Disease

Monitor liver function tests before and throughout treatment. Dose reduction required for moderate hepatic impairment. Safety in severe liver disease not established.

•     Cyclosporine: Significant increase in caspofungin exposure (~35%) and potential additive hepatotoxicity — avoid concurrent use; monitor LFTs closely if unavoidable

•     Rifampicin, nevirapine, efavirenz, carbamazepine, phenytoin, dexamethasone (CYP3A4 inducers): Reduce caspofungin levels — increase maintenance dose to 70 mg/day

•     Tacrolimus: Caspofungin may decrease tacrolimus blood levels by ~20% — monitor tacrolimus levels and adjust dose as needed

•     St John's Wort (herbal CYP inducer): May reduce caspofungin effectiveness — avoid

•     Do NOT mix with other IV drugs or dextrose-containing solutions — incompatible

•     Unopened vials: Refrigerate at 2–8°C

•     After reconstitution: Stable for up to 1 hour at room temperature (≤25°C)

•     Diluted infusion solution: Use within 24 hours at room temperature or 48 hours if refrigerated

•     Single use only — discard any unused portion

POM — Prescription Only Medicine. Hospital use only; administered by trained healthcare professionals.

If you are receiving caspofungin, you will be in the hospital and closely monitored by your medical team. Tell your nurse or doctor immediately if you notice: an increasing rash, difficulty breathing, a feeling of throat tightening, or any unusual symptoms during or after your infusion.

•     Loading dose is essential: Without the 70 mg loading dose, therapeutic steady-state is not reached for several days — always prescribe the loading dose on Day 1

•     Fungistatic vs fungicidal: Caspofungin is fungicidal against Candida but only fungistatic against Aspergillus — combination therapy with voriconazole may be considered for severe aspergillosis

•     EUCAST susceptibility: Check local epidemiology — Candida auris and some Candida glabrata strains may have reduced echinocandin susceptibility

•     Monitoring: LFTs twice weekly; blood cultures every 48 hours until clearance; assess for metastatic foci (echocardiogram in candidaemia)

•     Tacrolimus interaction: Critical in transplant patients — check tacrolimus trough levels twice weekly when starting or stopping caspofungin

•     Cyclosporine: Avoid concurrent use due to hepatotoxicity; if unavoidable, monitor LFTs daily

Q: Why am I receiving an antifungal if nobody has confirmed I have a fungal infection?

A: In patients with a weakened immune system and a fever that has not responded to antibiotics, a fungal infection is strongly suspected even without laboratory confirmation. Starting antifungal treatment promptly prevents a potential fungal infection from becoming life-threatening. If cultures later confirm a bacterial cause, antifungal therapy will be reviewed.

Q: Is caspofungin an antibiotic?

A: Caspofungin is an antifungal antibiotic — meaning it fights fungal infections, not bacterial ones. Standard antibiotics (penicillins, cephalosporins, etc.) do not affect fungi. Different types of infecting organisms require completely different types of treatment.

Q: How will the medical team know if caspofungin is working?

A: Your temperature should start reducing within 3–5 days. Blood cultures will be repeated every 48 hours to confirm fungal clearance. Your doctors will also monitor your inflammatory markers (CRP, white cell count) and imaging results to assess your response.