Caspofungin

Class

Echinocandin

Dose

70mg Load on Day 1, then 50mg od

Mechanism

Cidal

MoA

Inhibit fungal cell wall synthesis

Time v Conc

Concentration

Spectrum

Covers

Doesnt

Candida albicans

C. tropicalis

C. gibralta

Aspergillus species (variable activity)

Cryptococcus neoformans

Indications

Invasive candidosis – intraperitoneal abscesses, peritonitis, pleural infections

Candidemia

Invasive aspergillus – in patients who have failed to respond to / intolerant to other antifungal agents

PK

A

92% tissue distribution within 26-48hrs after IV infusion.  Poor OBA

D

97% PPB

M

Slow by hydrolysis and N-acetylation

E

35% feces, 41% urine, half life 9-11hrs (initial) then t1/2b 40-50hrs.  not cleared by haemodialysis

Caspo has triphasic pharmacokinetics;

  1. Tissue distribution accounts for initial rapid decline in plasma levels (hence the load to achieve SS quickly)
  2. The drug then undergoes slow hepatic metabolism
  3. And some spontaneous degradation

These processes combined account for the long terminal half life

AE

Fever, rash, N+V

Drug Interactions

Cyclosporin – elevates transaminases

Monitoring

LFTs.  Dose reduction required for liver insufficiency