Name /bks_53161_deglins_md_disk/caspofungin 02/11/2014 09:31AM Plate # 0-Composite pg 1 # 1

1 ritation at injection site. Misc: allergic reactions including ANAPHYLAXIS, ANGIO-

EDEMA, fever.
PDF Page #1
caspofungin (kas-po-fun-gin)
Cancidas Interactions
Classification Drug-Drug: Concurrent use with cyclosporine is not recommended due toqrisk
Therapeutic: antifungals (systemic) of hepatic toxicity. Maypblood levels and effects of tacrolimus. Blood levels and ef-
Pharmacologic: echinocandins fectiveness may bepby rifampin; maintenance dose should beqto 70 mg (in pa-
Pregnancy Category C tients with normal liver function). Blood levels and effectiveness also may bepby
efavirenz, nelfinavir, nevirapine, phenytoin, dexamethasone, or carbama-
zepine; anqin the maintenance dose to 70 mg should be considered in patients who
Indications are not clinically responding.
Invasive aspergillosis refractory to, or intolerant of, other therapies. Candidemia and
associated serious infections (intra-abdominal abscesses, peritonitis, pleural space
infections). Esophageal candidiasis. Suspected fungal infections in febrile neutro- Route/Dosage
penic patients. IV (Adults): 70 mg initially followed by 50 mg daily, duration determined by clinical
situation and response; Esophageal candidiasis— 50 mg daily, duration deter-
Action mined by clinical situation and response.
Inhibits the synthesis of ␤ (1, 3)-D-glucan, a necessary component of the fungal cell IV (Children ⱖ3 mo): 70 mg/m2 (max: 70 mg) initially followed by 50 mg/m2 daily
wall. Therapeutic Effects: Death of susceptible fungi. (max: 70 mg/day), duration determined by clinical situation and response.
Pharmacokinetics IV (Infants 1 to ⬍ 3 mo and Neonates): 25 mg/m2/dose once daily.
Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed to tissues. Hepatic Impairment
Protein Binding: 97%. IV (Adults): Moderate hepatic impairment— 70 mg initially followed by 35 mg
Metabolism and Excretion: Slowly and extensively metabolized; ⬍1.5% ex- daily, duration determined by clinical situation and response.
creted unchanged in urine.
Half-life: Polyphasic: ␤ phase— 9– 11 hr; ␥ phase— 40– 50 hr. NURSING IMPLICATIONS
TIME/ACTION PROFILE Assessment
ROUTE ONSET PEAK DURATION ● Assess patient for signs and symptoms of fungal infections prior to and periodi-
IV unknown end of infusion 24 hr cally during therapy.
● Monitor patient for signs of anaphylaxis (rash, dyspnea, stridor) during
Contraindications/Precautions therapy.
Contraindicated in: Hypersensitivity; Concurrent use with cyclosporine. ● Lab Test Considerations: May causeqserum alkaline phosphatase, serum
Use Cautiously in: Moderate hepatic impairment (pmaintenance dose recom- creatinine, AST, ALT, eosinophils, and urine protein and RBCs. May also causep
mended). serum potassium, hemoglobin, hematocrit, and WBCs.
Adverse Reactions/Side Effects
CNS: headache, chills. GI: diarrhea,qliver enzymes, nausea, vomiting. Resp: Potential Nursing Diagnoses
bronchospasm. GU:qcreatinine. Derm: flushing, pruritis, rash. Local: venous ir- Risk for infection (Indications)
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/caspofungin 02/11/2014 09:31AM Plate # 0-Composite pg 2 # 2

2 mitoxantrone, morphine, moxifloxacin, mycophenolate, nalbuphine, naloxone,

nicardipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin,
Implementation oxytocin, paclitaxel, palonosetron, pentamidine, pentazocine, phentolamine, PDF Page #2
phenylephrine, potassium chloride, procainamide, prochlorperazine, prometh-
IV Administration azine, propranolol, quinupristin/dalfopristin, remifentanil, rocuronium, strepto-
● pH: 6.6. zocin, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiopen-
● Intermittent Infusion: Diluent: Allow refrigerated vial to reach room temper- tal, thiotepa, tigecycline, tirofiban, tobramycin, topotecan, vancomycin,
ature. For 70-mg or 50-mg dose— Reconstitute vials with 10.8 mL of 0.9% NaCl, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, vori-
sterile water for injection, Bacteriostatic Water for Injection with methylparaben conazole, zidobudine, zoledronic acid.
and propylparaben, or Bacteriostatic Water for Injection with 0.9% benzyl alco- ● Y-Site Incompatibility: amphotericin B colloidal, amphotericin B lipid com-
hol. Use preservative free diluents for neonates. Do not dilute with dextrose solu- plex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, bivalirudin, ce-
tions. Reconstituted solution is stable for 1 hr at room temperature. Withdraw 10 fazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, cef-
mL from vial and add to 250 mL of 0.9% NaCl, 0.45% NaCl, 0.225% NaCl, or LR. triaxone, cefuroxime, chloramphenicol, clindamycin, dantrolene,
The 50-mg dose also can be diluted in 100 mL when volume restriction is neces- dexamethasone sodium phosphate, diazepam, digoxin, doxacurium, enalaprilat,
sary. Infusion is stable for 24 hr at room temperature or 48 hr if refrigerated. For ephedrine, ertapenem, fluorouracil, foscarnet, fosphenytoin, furosemide, hepa-
35-mg dose— Reconstitute a 50-mg or 70-mg vial as per the directions above. rin, ketorolac, lidocaine, methotrexate, methylprednisolone sodium succinate,
Remove the volume of drug equal to the calculated loading dose or calculated nafcillin, nitroprusside, pamidronate, pancuronium, pemetrexed, pentobarbital,
maintenance dose based on a concentration of 7 mg/mL (if reconstituted from the phenobarbital, phenytoin, piperacillin/tazobactam, potassium phosphates, rani-
70-mg vial) or a concentration of 5 mg/mL (if reconstituted from the 50-mg vial). tidine, sodium acetate, sodium bicarbonate, sodium phosphates, ticarcillin/cla-
White cake should dissolve completely. Mix gently until a clear solution is ob- vulanate, trimethoprim/sulfamethoxazole.
tained. Do not use a solution that is cloudy, discolored, or contains precipitates. ● Solution Incompatibility: Solutions containing dextrose.
Concentration: 0.14– 0.47 mg/mL. Rate: Infuse over 1 hr.
● Y-Site Compatibility: alfentanil, allopurinol, amifostine, amikacin, aminophyl- Patient/Family Teaching
line, amiodarone, anidulafungin, atracurium, aztreonam, bleomycin, bumeta- ● Explain the purpose of caspofungin to patient and family.
nide, busulfan, butorphanol, calcium acetate, calcium chloride, calcium gluco- ● Advise patient to notify health care professional immediately if symp-
nate, carboplatin, carmustine, chlorpromazine, cimetidine, ciprofloxacin, toms of allergic reactions (rash, facial swelling, pruritus, sensation of
cisatracurium, cisplatin, cyclophosphamide, cyclosporine, dacarbazine, dactino- warmth, difficulty breathing) occur.
mycin, daptomycin, daunorubicin, dexmedetomidine, dexrazoxane, diltiazem, di-
phenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, dox- Evaluation/Desired Outcomes
orubicin, doxycycline, droperidol, epinephrine, epirubicin, erythromycin, ● Decrease in signs and symptoms of fungal infections. Duration of therapy is deter-
esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, flu- mined based on severity of underlying disease, recovery from immunosuppres-
conazole, fludarabine, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, sion, and clinical response.
granisetron, haloperidol, hydrocortisone sodium succinate, hydromorphone,
idarubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, la- Why was this drug prescribed for your patient?
betalol, leucovorin, levofloxacin, linezolid, magnesium sulfate, mannitol, mech-
lorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methyl-
dopate, metoclopramide, metoprolol, midazolam, milrinone, mitomycin,
䉷 2015 F.A. Davis Company