Caspofungin

INTRODUCTION

Indications

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 neutropenic patients.

Action

Inhibits the synthesis of β (1,3)-D-glucan, a necessary component of the fungal cell wall. Therapeutic Effects: Death of susceptible fungi.

Adverse Reactions/Side Effects

CNS: headache. GI: diarrhea, nausea, vomiting. Derm: flushing. Local: venous irritation at injection site. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct patient to report other troublesome side effects such as prolonged or severe headache, fever, flushing, or GI reactions (diarrhea, nausea, vomiting).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Protein Binding: 97%.

Metabolism and Excretion: Slowly and extensively metabolized; <1.5% excreted unchanged in urine.

Half-life: Polyphasic: β phase—9–11 hr; γ phase—40–50 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Concurrent use with cyclosporine.

Use Cautiously in: Moderate hepatic impairment (decreased maintenance dose recommended); Pedi: Children <3 mo (safety not established).

Interactions

Drug-Drug: Concurrent use with cyclosporine is not recommended due to ↑ risk of hepatic toxicity. May ↓ blood levels and effects of tacrolimus. Blood levels and effectiveness may be ↓ by rifampin; maintenance dose should be ↑ to 70 mg (in patients with normal liver function). Blood levels and effectiveness may be also be ↓ by efavirenz, nelfinavir, nevirapine, phenytoin, dexamethasone, or carbamazepine. An ↑ in the maintenance dose to 70 mg should be considered in patients who are not clinically responding.

Route/Dosage

IV (Adults): 70 mg initially followed by 50 mg daily, duration determined by clinical situation ...