Medication Guide App

Caspofungin Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Aspergillosis - Invasive

In patients refractory to or intolerant of other therapies:
Loading dose: 70 mg IV on day 1
Maintenance dose: 50 mg IV once a day

Duration of therapy should be based on the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.

Usual Adult Dose for Candidemia

Candidemia and the following Candida infections - intraabdominal abscesses, peritonitis, and pleural space infections:
Loading dose: 70 mg IV on day 1
Maintenance dose: 50 mg IV once a day

Duration of therapy should be dictated by 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 warrant a longer course of therapy pending resolution of the neutropenia.

Usual Adult Dose for Esophageal Candidiasis

50 mg IV once a day for 7 to 14 days after symptom resolution

A 70 mg loading dose has not been studied with this indication. Because of the risk of relapse of oropharyngeal candidiasis in patients with HIV infections, suppressive oral therapy could be considered.

Usual Adult Dose for Febrile Neutropenia

Empirical therapy for presumed fungal infections:
Loading dose: 70 mg IV on day 1
Maintenance dose: 50 mg IV once a day

Duration of treatment should be based on the patient's clinical response. Empirical therapy should continue until resolution of neutropenia. Patients found to have a fungal infection should be treated for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved. If the 50 mg dose is well tolerated but does not provide an adequate clinical response, the daily dose can be increased to 70 mg.

Usual Pediatric Dose for Candidemia

Candidemia and the following Candida infections - intraabdominal abscesses, peritonitis, and pleural space infections:
3 months or older:
Loading dose: 70 mg/m2 IV on day 1
Maintenance dose: 50 mg/m2 IV once a day

The maximum loading dose and the daily maintenance dose should not exceed 70 mg, regardless of the patient's calculated dose. If the 50 mg/m2 daily dose is well tolerated but does not provide adequate clinical response, the daily dose can be increased to 70 mg/m2 daily (not to exceed 70 mg).

Duration of therapy should be dictated by 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 warrant a longer course of therapy pending resolution of the neutropenia.

Usual Pediatric Dose for Aspergillosis - Invasive

In patients refractory to or intolerant of other therapies:
3 months or older:
Loading dose: 70 mg/m2 IV on day 1
Maintenance dose: 50 mg/m2 IV once a day

The maximum loading dose and the daily maintenance dose should not exceed 70 mg, regardless of the patient's calculated dose. If the 50 mg/m2 daily dose is well tolerated but does not provide adequate clinical response, the daily dose can be increased to 70 mg/m2 daily (not to exceed 70 mg).

Duration of therapy should be based on the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.

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 for 7 to 14 days after symptom resolution

The maximum loading dose and the daily maintenance dose should not exceed 70 mg, regardless of the patient's calculated dose. If the 50 mg/m2 daily dose is well tolerated but does not provide adequate clinical response, the daily dose can be increased to 70 mg/m2 daily (not to exceed 70 mg).

Because of the risk of relapse of oropharyngeal candidiasis in patients with HIV infections, suppressive oral therapy could be considered.

Usual Pediatric Dose for Febrile Neutropenia

Empirical therapy for presumed fungal infections:
3 months or older:
Loading dose: 70 mg/m2 IV on day 1
Maintenance dose: 50 mg/m2 IV once a day

The maximum loading dose and the daily maintenance dose should not exceed 70 mg, regardless of the patient's calculated dose. If the 50 mg/m2 daily dose is well tolerated but does not provide adequate clinical response, the daily dose can be increased to 70 mg/m2 daily (not to exceed 70 mg).

Duration of treatment should be based on the patient's clinical response. Empirical therapy should continue until resolution of neutropenia. Patients found to have a fungal infection should be treated for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Adults:
Mild hepatic dysfunction (Child-Pugh score 5 to 6): No adjustment recommended.

Moderate hepatic dysfunction (Child-Pugh score 7 to 9):
Loading dose (where recommended): 70 mg IV on day 1
Maintenance dose: 35 mg IV once a day

Severe hepatic dysfunction (Child-Pugh score greater than 9): Data not available

Pediatrics: Data not available

Dose Adjustments

Adults:
On rifampin: Should receive 70 mg of caspofungin once a day

On nevirapine, efavirenz, carbamazepine, dexamethasone, or phenytoin: May require an increase in dose to 70 mg of caspofungin once a day

Pediatrics:
Coadministered with inducers of drug clearance, such as rifampin, efavirenz, nevirapine, phenytoin, dexamethasone, or carbamazepine: A caspofungin dose of 70 mg/m2 once a day (not to exceed 70 mg) should be considered

Precautions

Caspofungin is not indicated as initial therapy for invasive aspergillosis. The safety and efficacy of a dose of 150 mg daily have been studied in 100 adult patients with candidemia and other Candida infections. The efficacy at this higher dose was not significantly better than the efficacy of the 50 mg daily dose. The efficacy of doses above 50 mg daily in the other adult patients for whom caspofungin is indicated is unknown.

Laboratory abnormalities in liver function tests (LFTs) have been seen in healthy volunteers and patients administered caspofungin. In some patients with serious underlying conditions who were receiving multiple concomitant medications along with caspofungin, isolated cases of clinically significant hepatic dysfunction, hepatitis, and hepatic failure have been observed in patients; a causal relationship to caspofungin has not been determined. Patients who develop abnormal LFTs during caspofungin treatment should be monitored for evidence of worsening hepatic function and evaluated for risk/benefit of continuing caspofungin treatment.

Clinical studies of caspofungin therapy did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Although the number of elderly patients was not large enough for a statistical analysis, no overall differences in safety or efficacy were reported between these and younger patients. Plasma concentrations of caspofungin in healthy elderly men and women (65 years of age or older) were increased slightly (approximately 28% in AUC) compared to young healthy men. A similar effect of age on pharmacokinetics was observed in patients with candidemia or other Candida infections (intraabdominal abscesses, peritonitis, or pleural space infections). No dose adjustment is advised for the elderly; however, greater sensitivity of some older individuals cannot be ruled out.

Safety and effectiveness have not been established in pediatric patients less than 3 months of age.

Dialysis

Caspofungin is not removed by hemodialysis, thus supplementary dosing is not required following hemodialysis.

Other Comments

Caspofungin should be administered by slow IV infusion over approximately 1 hour.

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