Neonatal Drug Therapy Manual

Caspofungin

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Updated March 5, 2024 - 2:33pm

Alternate Name(s): 
Cancidas
Classification: 
Antifungal
Original Date: 
August 2003
Revised Date: 
April 2012
Indications: 
  • Treatment of invasive aspergillosis and candida infections
Administration: 
  • IV intermittent infusion: over 1 hour
Dosage: 
  • 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
Compatibility: 

- 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

References: 

- 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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