Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Original Date: 
August 2003
Revised Date: 
April 2012
  • Treatment of invasive aspergillosis and candida infections
  • IV intermittent infusion: over 1 hour
  • Preterm, neonates to infants < 3 months
    • 25 mg/m2/dose once daily

  • Infants with corrected GA > 42 weeks and > 3 months
    • Initial dose: 70 mg/m2/dose on Day 1
    • Subsequent dose: 50 mg/m2/dose once daily

* For patients receiving dexamethasone, nevirapine, phenytoin or rifampin (and possibly other enzyme inducers), consider 70 mg/m2/dose once daily

Formula for Body Surface Area (BSA):

Click here for BSA Formula

Side Effects: 
  • CVS: hypertension, hypotension, peripheral edema, tachycardia
  • Endocrine and metabolic: hyperkalemia, hypokalemia
  • GI: abdominal pain, diarrhea, nausea, vomiting
  • Hematologic: anemia
  • Hepatic: increased ALT, AST and alkaline phosphatase, increased serum bilirubin
  • Miscellaneous: fever, histamine release- anaphylaxis (infusion rate related)
  • Renal: hematuria, proteinuria, increased serum creatinine
  • Respiratory: bronchospasm, dyspnea  
Parameters to Monitor: 
  • Periodic liver function tests
  • Serum potassium
  • CBC, hemoglobin
Reconstitution and Stability: 
  • Caspofungin 50 mg vial:
    • Add 10.5 mL of SWFI to get 5 mg/mL
    • Take 2 mL (10 mg) and add to 18 mL 0.9% NaCl
    • Final concentration: 0.5 mg/mL

- Solutions Compatible: 0.9% NaCl, 0.45% NaCl

- Y-site Compatible: when the following drugs are diluted in 0.9 % NaCl:  dobutamine, dopamine, fentanyl, midazolam and morphine

- Incompatible: dextrose solutions, TPN


- Lau E. (Editor). Drug Handbook and Formulary- The Hospital for Sick Children. Toronto: 2011-2012

- Saez-Llorens X, Macias M, Maiya P, et al.  Pharmacokinetics and Safety of Caspofungin in Neonates and Infants Less Than 3 Monthsof Age. Antimicrob Agents Chemother 2009, 53 (3): 869-75

- Li C, Sun P, Dong Y, Bi S, Desai R, Dockendorf MF, and al.  Population Pharmacokinetics of Caspofungin in Pediatric Patients.  Antimicrobial Agents and Chemotherapy, May 2011, p 2098-2105

- Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 17th Edition. Hudson: Lexi-Comp Inc; 2010

- Trissel LA. Handbook on Injectable Drugs 16th Edition. Bethesda; American Society of Health-System Pharmacists. 2011


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