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CASPOFUNGIN 50 MG POWDER FOR CONCENTRATE FOR SOLUTION FOR INFUSION

Active substance(s): CASPOFUNGIN / CASPOFUNGIN ACETATE

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PACKAGE LEAFLET: INFORMATION FOR THE USER

Caspofungin 50 mg powder for concentrate for solution
for infusion
caspofungin
Read all of this leaflet carefully before you are given this medicine because it contains
important information for you.
• Keep this leaflet. You may need to read it again.
• If you have further questions, please ask your doctor, pharmacist or nurse.
• If you get any side effects, talk to your doctor, pharmacist or nurse.
This includes any possible side effects not listed in this leaflet. See section 4.
What is in this leaflet
1. What Caspofungin is and what it is used for
2. What you need to know before you are given Caspofungin
3. How to use Caspofungin
4. Possible side effects
5. How to store Caspofungin
6. Contents of the pack and other information

1. What Caspofungin is and what it is used for
What Caspofungin is
Caspofungin contains a medicine called caspofungin. This belongs to a group of medicines called
antifungals.
What Caspofungin is used for
Caspofungin is used to treat the following infections in children, adolescents and adults:
• serious fungal infections in your tissues or organs (called ‘invasive candidiasis’). This infection
is caused by fungal (yeast) cells called Candida.
• People who might get this type of infection include those who have just had an operation or
those whose immune systems are weak. Fever and chills that do not respond to an antibiotic
are the most common signs of this type of infection.
• fungal infections in your nose, nasal sinuses or lungs (called ‘invasive aspergillosis’) if other
anti-fungal treatments have not worked or have caused side effects. This infection is caused by
a mould called Aspergillus.
• People who might get this type of infection include those having chemotherapy, those who have
had a transplant and those whose immune systems are weak.
• suspected fungal infections if you have a fever and a low white cell count that have not improved
on treatment with an antibiotic. People who are at risk of getting a fungal infection include those
who have just had an operation or those whose immune systems are weak.
How Caspofungin works
Caspofungin makes fungal cells fragile and stops the fungus from growing properly. This stops
the infection from spreading and gives the body’s natural defences a chance to completely get rid
of the infection.

2. What you need to know before you are given Caspofungin
Do not use Caspofungin
• if you are allergic to caspofungin or any of the other ingredients of this medicine (listed in
section 6).
If you are not sure, talk to your doctor, nurse or pharmacist before you are given your medicine.
Warnings and precautions
Talk to your doctor, nurse or pharmacist before you are given Caspofungin if:
• you are allergic to any other medicines
• you have ever had liver problems – you might need a different dose of this medicine
• you are already taking cyclosporin (used to help prevent organ transplant rejection or to
suppress your immune system) – as your doctor may need to run extra blood tests during your
treatment
• if you have ever had any other medical problem.
If any of the above applies to you (or you are not sure), talk to your doctor, nurse or pharmacist
before you are given Caspofungin.
Other medicines and Caspofungin
Please tell your doctor, nurse or pharmacist if you are taking, have recently taken or might take
any other medicines. This includes medicines obtained without a prescription, including herbal
medicines. This is because Caspofungin can affect the way some other medicines work.
Also some other medicines can affect the way caspofungin works.
Tell your doctor, nurse or pharmacist if you are taking any of the following medicines:
• cyclosporin or tacrolimus (used to help prevent organ transplant rejection or to suppress your
immune system) as your doctor may need to run extra blood tests during your treatment
• some HIV medicines such as efavirenz or nevirapine
• phenytoin or carbamazepine (used for the treatment of seizures)
• dexamethasone (a steroid)
• rifampicin (an antibiotic).
If any of the above apply to you (or you are not sure), talk to your doctor, nurse or pharmacist
before you are given Caspofungin.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby,
ask your doctor or pharmacist for advice before taking this medicine.
• Caspofungin has not been studied in pregnant women. It should be used in pregnancy only if
the potential benefit justifies the potential risk to the unborn baby.
• Women given caspofungin should not breast-feed.
Driving and using machines
There is no information to suggest that Caspofungin affects your ability to drive or operate
machinery.

3. How to use Caspofungin
Caspofungin will always be prepared and given to you by a healthcare professional.
You will be given Caspofungin :
• once each day
• by slow injection into a vein (intravenous infusion)
• over about 1 hour
Your doctor will determine the duration of your treatment and how much caspofungin you will be
given each day.
Your doctor will monitor how well the medicine works for you. If you weigh more than 80 kg, you
may need a different dose.

Children and adolescents
The dose for children and adolescents may differ from the adult dose.

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If you have been given more Caspofungin than you should
Your doctor will decide how much Caspofungin you need and for how long each day. If you are
worried that you may have been given too much caspofungin, tell your doctor or nurse straight away.
If you have any further questions on the use of this medicine, ask your doctor, nurse or pharmacist.

4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Tell your doctor or nurse straight away if you notice any of the following side effects – you
may need urgent medical treatment:
• rash, itching, feeling warm, swelling of your face, lips or throat or difficulty breathing – you may
be having a histamine reaction to the medicine
• difficulty breathing with wheezing or a rash that gets worse – you may be having an allergic
reaction to the medicine
• cough, serious breathing difficulties – if you are an adult and have invasive aspergillosis you
may be experiencing a serious respiratory problem that could result in respiratory failure.
As with any prescription medicine, some side effects may be serious. Ask your doctor for more
information.
Other side effects in adults include
Common: may affect up to 1 in 10 people:
• Decreased haemoglobin (decreased oxygen carrying substance in the blood), decreased white
blood cells
• Decreased blood albumin (a type of protein) in your blood, decreased potassium or low
potassium levels in the blood
• Headache
• Inflammation of the vein
• Shortness of breath
• Diarrhoea, nausea or vomiting
• Changes in some laboratory blood tests (including increased values of some liver tests)
• Itching, rash, skin redness or sweating more than usual
• Joint pain
• Chills, fever
• Itching at the injection site.
Uncommon: may affect up to 1 in 100 people:
• Changes in some laboratory blood tests (including disease of blood clotting, platelets, red blood
cells and white blood cells)
• Loss of appetite, increase in amount of body fluid, imbalance of salt in the body, high sugar
level in the blood, low calcium level in the blood, low magnesium level in the blood, increase in
acid level in the blood
• Disorientation, feeling nervous, being unable to sleep
• Feeling dizzy, decreased feeling or sensitivity (especially in the skin), shaking, feeling sleepy,
change in the way things taste, tingling or numbness
• Blurred vision, increase in tears, swollen eyelid, yellowing of the whites of the eyes (jaundice)
• Sensation of fast or irregular heart beats, rapid heart beat, irregular heart beat, abnormal heart
rhythm, heart failure
• Flushing, hot flush, high blood pressure, low blood pressure, redness along a vein which is
extremely tender when touched
• Tightening of the bands of muscle around the airways (bronchospasm) resulting in wheezing or
coughing, fast breathing rate, shortness of breath that wakes you up, shortage of oxygen in the
blood, abnormal breath sounds, crackling sounds in the lungs, wheezing, nasal congestion,
cough, throat pain
• Belly pain, upper belly pain, bloating, constipation, difficulty swallowing, dry mouth, indigestion,
passing gas, stomach discomfort, swelling due to build-up of fluid around the belly
• Decreased flow of bile, enlarged liver, yellowing of the skin and/or whites of the eyes, liver injury
caused by a drug or chemical, liver disorder
• Abnormal skin tissue, generalised itching, hives, rash of varying appearance, abnormal skin,
red often itchy spots on your arms and legs and sometimes on the face and the rest of the body
• Back pain, pain in an arm or leg, bone pain, muscle pain, muscle weakness
• Loss of kidney function, sudden loss of kidney function
• Catheter site pain, injection site complaints (redness, hard lump, pain, swelling, irritation, rash,
hives, leaking of fluid from the catheter into the tissue), inflammation of vein at injection site
• Increased blood pressure and alterations in some laboratory blood tests (including kidney
electrolyte and clotting tests), increased levels of the medicines you are taking that weaken the
immune system
• Chest discomfort, chest pain, feeling of body temperature change, generally feeling unwell,
general pain, swelling of the face, swelling of the ankles, hands or feet, swelling, tenderness,
feeling tired.
Side effects in children and adolescents
Very common: may affect more than 1 in 10 people:
• Fever
Common: may affect up to 1 in 10 people:
• Headache
• Fast heart beat
• Flushing, low blood pressure
• Changes in some laboratory blood tests (increased values of some liver tests)
• Itching, rash
• Catheter site pain
• Chills
• Changes in some laboratory blood tests.
Other side effects reported since this medicine has been on the market
Not known: frequency cannot be estimated:
• Liver problems
• Swelling of the ankles, hands or feet
• Increased calcium levels in the blood have been reported.
Reporting of side effects
If you get any side effects, talk to your doctor, nurse or pharmacist.
This includes any possible side effects not listed in this leaflet. You can also report side effects
directly via the Yellow Card Scheme (www.mhra.gov.uk/yellowcard).
By reporting side effects you can help provide more information on the safety of this medicine.

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5. How to store Caspofungin
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton and the vial as EXP.
The expiry date refers to the last day of that month.

PREPARATION OF THE SOLUTION FOR INFUSION IN ADULTS
DOSE*

Volume of
reconstituted
Caspofungin
for transfer to
intravenous
bag or bottle

Standard preparation
(reconstituted
Caspofungin added to
250 ml) final
concentration

Reduced volume infusion
(reconstituted Caspofungin
added to 100 ml) final
concentration

50 mg

10 ml

0.20 mg/ml

-

50 mg at
reduced
volume

10 ml

-

0.47 mg/ml

35 mg for
moderate
hepatic
impairment
(from one
50 mg vial)

7 ml

0.14 mg/ml

-

35 mg for
moderate
hepatic
impairment
(from one
50 mg vial)
at reduced
volume

7 ml

-

0.34mg/ml

Store in a refrigerator (2°C to 8°C).
Reconstituted concentrate: should be used immediately. Stability data have shown that the
concentrate for solution for infusion can be stored for up to 24 hours when the vial is stored at
25°C or less and reconstituted with water for injection.
Diluted patient infusion solution: should be used immediately. Stability data have shown that the
product can be used within 24 hours when stored at 25°C or less, or within 48 hours when the
intravenous infusion bag (bottle) is stored refrigerated (2 to 8°C) and diluted with compatible
infusion solution.
From a microbiological point of view, the product should be used immediately. If not used
immediately, in use storage times and conditions prior to use are the responsibility of the user and
would normally not be longer than 24 hours at 2 to 8°C, unless reconstitution and dilution have
taken place in controlled validated aseptic conditions.
Once Caspofungin has been prepared, it should be used straight away. This is because it does
not contain any ingredients to stop the growth of bacteria. Only a trained healthcare professional
who has read the complete directions should prepare the medicine (please see below
“Instructions of how to reconstitute and dilute Caspofungin”).
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how
to throw away medicines you no longer use. These measures will help to protect the environment.

6. Contents of the pack and other information
What Caspofungin contains
• The active substance is caspofungin. Each vial of Caspofungin contains 50 mg of caspofungin
(as acetate). The concentration of the reconstituted vial is 5.2 mg/ml.
• The other ingredients are sucrose, mannitol, succinic acid and sodium hydroxide.
What Caspofungin looks like and contents of the pack
Caspofungin is a sterile, white to off-white compact powder.
Each pack contains one vial of powder.

* 10.5 ml should be used for reconstitution of all vials
INSTRUCTIONS FOR USE IN PAEDIATRIC PATIENTS
Calculation of Body Surface Area (BSA) for paediatric dosing
Before preparation of infusion, calculate the body surface area (BSA) of the patient using the
following formula: (Mosteller Formula)1

1 Mosteller RD: Simplified Calculation of Body Surface Area. N Engl J Med 1987 Oct 22;317(17): 1098 (letter)

Marketing Authorisation Holder
Sandoz Limited
Frimley Business Park,
Frimley,
Camberley,
Surrey,
GU16 7SR,
UK
Manufacturer
Xellia Pharmaceuticals ApS
Dalslandsgade 11
DK-2300 Copenhagen S
Denmark

This leaflet was last revised in: 10/2016
The following information is intended for medical or healthcare professionals only:
Instructions of how to reconstitute and dilute Caspofungin:
Reconstitution of Caspofungin
DO NOT USE ANY DILUENTS CONTAINING GLUCOSE as Caspofungin is not stable in
diluents containing glucose. DO NOT MIX OR CO-INFUSE CASPOFUNGIN WITH ANY OTHER
MEDICINES, as there are no data available on the compatibility of Caspofungin with other
intravenous substances, additives, or medicinal products. Visually inspect the infusion solution for
particulate matter or discolouration.
INSTRUCTIONS FOR USE IN ADULT PATIENTS
Step 1 Reconstitution of conventional vials
To reconstitute the powder bring the vial to room temperature and aseptically add 10.5 ml of water
for injection. The concentrations of the reconstituted vials will be 5.2 mg/ml.
The white to off-white compact lyophilised powder will dissolve completely. Mix gently until a clear
solution is obtained. Reconstituted solutions should be visually inspected for particulate matter or
discolouration.
This reconstituted solution may be stored for up to 24 hours at or below 25°C.
Step 2 Addition of reconstituted Caspofungin to patient infusion solution
Diluents for the final solution for infusion are: sodium chloride solution for injection, or lactated
Ringer’s solution. The solution for infusion is prepared by aseptically adding the appropriate
amount of reconstituted concentrate (as shown in the table below) to a 250 ml infusion bag or
bottle. Reduced volume infusions in 100 ml may be used, when medically necessary, for 50 mg or
35 mg daily doses. Do not use if the solution is cloudy or has precipitated.

BSA (m2) =

Height (cm) X Weight (kg)
3600

Preparation of the 70 mg/m2 infusion for paediatric patients >3 months of age
(using a 50-mg vial)
1. Determine the actual loading dose to be used in the paediatric patient by


using the patient’s BSA (as calculated above) and the following equation:
BSA (m2) X 70 mg/m2 = Loading Dose
The maximum loading dose on Day 1 should not exceed 70 mg regardless of the patient’s
calculated dose.
2. Equilibrate the refrigerated vial of Caspofungin to room temperature.
3. Aseptically add 10.5 ml water for injection.a This reconstituted solution may be stored for
up to 24 hours at or below 25°C.b This will give a final Caspofungin concentration in the vial of
5.2 mg/ml.
4. Remove the volume of medicine equal to the calculated loading dose (Step 1) from
the vial. Aseptically transfer this volume (ml)c of reconstituted Caspofungin to an IV bag (or
bottle) containing 250 ml of 0.9 %, 0.45 %, or 0.225 % Sodium Chloride Injection, or Lactated
Ringers Injection. Alternatively, the volume (ml)c of reconstituted Caspofungin can
be added to a reduced volume of 0.9 %, 0.45 %, or 0.225 % Sodium Chloride Injection or
Lactated Ringers Injection, not to exceed a final concentration of 0.5 mg/ml. This infusion
solution must be used within 24 hours if stored at or below 25°C or within 48 hours if stored
refrigerated at 2 to 8°C.
Preparation of the 50 mg/m2 infusion for paediatric patients >3 months of age (using a
50-mg vial)
1. Determine the actual daily maintenance dose to be used in the paediatric patient by using the
patient’s BSA (as calculated above) and the following equation: BSA (m2) X 50 mg/m2 = Daily
Maintenance Dose
The daily maintenance dose should not exceed 70 mg regardless of the patient’s calculated
dose.
2. Equilibrate the refrigerated vial of Caspofungin to room temperature.
3. Aseptically add 10.5 ml of water for injection.a This reconstituted solution may be stored
for up to 24 hours at or below 25°C.b This will give a final Caspofungin concentration in the vial
of 5.2 mg/ml.
4. Remove the volume of medicine equal to the calculated daily maintenance dose (Step
1) from the vial. Aseptically transfer this volume (ml)c of reconstituted Caspofungin to an IV
bag (or bottle) containing 250 ml of 0.9 %, 0.45 %, or 0.225 % Sodium Chloride Injection, or
Lactated Ringers Injection. Alternatively, the volume (ml)c of reconstituted Caspofungin can
be added to a reduced volume of 0.9 %, 0.45 %, or 0.225 % Sodium Chloride Injection or
Lactated Ringers Injection, not to exceed a final concentration of 0.5 mg/ml. This infusion
solution must be used within 24 hours if stored at or below 25°C or within 48 hours if stored
refrigerated at 2 to 8°C.

Preparation notes:
The white to off-white cake will dissolve completely. Mix gently until a clear solution is
obtained.
a

Visually inspect the reconstituted solution for particulate matter or discoloration during
reconstitution and prior to infusion. Do not use if the solution is cloudy or has precipitated.
b

Caspofungin is formulated to provide the full labeled vial dose (50 mg) when 10 ml is
withdrawn from the vial.
c



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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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