Echinocandin
Candida sp. including azole-resistant strains. Activity against molds difficult to quantify but includes Aspergillus sp Table 1, Table 2
Non-competitive inhibition of the enzyme b-(1,3)-glucan synthase.
Echinocandins have more fungicidal effects against Candida species compared to filamentous organisms. In-vitro studies have demonstrated concentration-dependent fungicidal activity against Candida sp.
Half-life: 9-11 hours; Volume of distribution: 9.67L; Clearance (total): 12ml/min; Protein binding: 97%; Table 3
Hepatic: mild elevation in liver transaminases – dose related and reversible upon discontinuation of drug
Body as a whole: Fever
Respiratory: Wheezing, Bronchoconstriction
Dermatologic: Edema, flushing, wheals, rash
Metabolic: Hypercalcemia (Postmarketing experience)
Intravenous only – available as 50mg and 70mg powder for reconstitution vials.
70mg loading dose IV x 1, followed by 50mg IV q24h
Disease state based dosing:
Hepatic failure: In mild hepatic impairment, daily maintenance doses should be 35mg IV q24h
Renal failure: No dosing adjustment recommended
Cyclopsorin: Increases the AUC of Caspofungin by 35%, with associated elevations in ALT and AST elevations
Tacrolimus: Concomitant administration decreases AUC of tacrolimus by 20%. Montoring of tacrolimus blood concentrations recommended
Other: Reductions in caspofungin concentrations may occur when coadministered with inducers of drug clearance such as efavirenz, nevirapine, phenytoin, dexamethasone, or carbamazepine. Caspofungin dose escalation may be considered in this setting
Category C: Risk unknown. Human studies inadequate.
Routine monitoring of hepatic enzymes is recommended
Cancidas/Merck pharmaceuticals
§ U.S.A., United Kingdom, Australia, Chile, Sweden, Denmark, France, Israel, Finland, Belgium, Norway, Italy, Germany, Switzerland, Czech Republic, Thailand, Spain, Canada, Ireland, Hong Kong, Singapore, New Zealand