Caspofungin is an antifungal drug, the first of a new class termed the echinocandins. It shows activity against infections with Aspergillus and Candida, and works by inhibiting cell wall synthesis. It is administered intravenously. more...
Currently caspofungin acetate has been approved by the FDA for the treatment of invasive aspergillosis in patients whose disease is refractory to, or who are intolerant of, other first-line antifungal agents (i.e. conventional or liposomal amphotericin B preparations and flucytosine or itraconazole). Caspofungin acetate itself has so far not been studied as first-line therapy for aspergillosis or other mycotic diseases.
Caspofungin can be tried as empirical therapy against invasive forms of Candidosis in adult patients.
Thirty six (36) percent of patients refractory to other therapies responded well to caspofungin therapy, while even 70% of patients intolerant to other therapies were classified as responders. Direct comparative studies to other drugs in the treatment of invasive aspergillosis have so far not been undertaken.
Known hypersensitivity to caspofungin acetate or any other ingredient contained in the formulation
The concomitant use of caspofungin and cyclosporine in healthy volunteers led to a more frequent increase of liver enzymes (ALT=SGPT and AST=SGOT) than noted with cyclosporine alone. Combination treatment is only indicated, if the potential benefit for the patient outweighs the potential risk.
Dosage reduction in patients with moderately impaired liver function is recommended. No clinical data exists regarding the use of caspofungin in patients with severely impaired liver function.
Reactions due to histamine release (rash, facial swelling, pruritus, sensation of warmth and one case of anaphylaxis) have been seen. Those reactions should be carefully watched for.
In clinical studies development of resistance in Aspergillus spp., the causative fungus of aspergillosis, has so far not been seen. Likewise, experiments on the emergence of resistance with fungi-cultures and studies in animals were negative. However, the emergence of resistance cannot be excluded.
Pregnancy and Lactation
Caspofungin has been assigned to class C.
Capsofungin is found in the milk of lactating rats; it is not known, whether this effect can be seen in women, too. Lactating women should be treated cautiously.
Ordinarily, no dose adjustments are necessary.
There is no sufficient clinical experience to judge the safety and efficacy in patients younger than 18 years of age.
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