Pharmaceutical Caspofungin For Treating certain fungal infections 162808-62-0

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1. Candida Infections

Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections
Day 1 loading dose: 70 mg IV infused over 1 hr (as a single dose)
Maintenance: 50 mg IV qDay infused over 1 hr
Continue antifungal therapy for at least 14 days after last positive culture; patients who remain persistently neutropenic may warrant longer course of therapy pending resolution of neutropenia

2. Esophageal Candidiasis

Indicated for treatment of esophageal candidiasis
50 mg IV qDay infused over 1 hr, continue for 7-14 days after symptom resolution
Loading dose not necessary, has not been studied with this indication
May consider suppressive oral therapy in patients with HIV infection because of the risk of oropharyngeal candidiasis relapse

3. Invasive Aspergillosis

Indicated for invasive aspergillosis in patients refractory to or intolerant of other therapies (eg, amphotericin B, itraconazole)
Day 1 loading dose: 70 mg IV infused over 1 hr (as a single dose)
Maintenance: 50 mg IV qDay infused over 1 hr
Duration of treatment should be based upon the severity of the underlying disease, recovery from immunosuppression, and clinical response.

4. Febrile Neutropenia

Empirical therapy for presumed fungal infections in febrile, neutropenic patients
Day 1 loading dose: 70 mg IV infused over 1 hr
Maintenance: 50 mg IV qDay infused over 1 hour; if well tolerated but not achieving adequate response, may increase to 70 mg IV qDay
Duration of treatment should be based on clinical response; continue empirical therapy until resolution of neutropenia
If fungal infection is confirmed, continue therapy for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved

5. Dosage Modifications

Coadministration with strong CYP inducers (rifampin): 70 mg IV qDay
Coadministration with other drug clearance inducers: Consider increasing to 70 mg IV qDay

6. Hepatic Impairment

Mild Child-Pugh 5-6: No dosage adjustment necessary
Moderate Child-Pugh 7-9: Load 70 mg IV, then 35 mg IV qDay
Severe Child-Pugh >9: Safety and efficacy not established